Organization
WAL-MART STORES EAST , LP
Active
Other names
WAL-MART PHARMACY 10-2890
Organization subpart
No
Provider details
NPI number
Authorized official
MATTHEW MCMULLIN (DIRECTOR)
(479) 371-8711
Entity
Organization
Contact information
Practice address
5955 ZEBULON RD, MACON, GA 31210-2030
(478) 471-9122
Mailing address
702 SW 8TH ST, BENTONVILLE, AR 72716-0445
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
PHRE008801
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00940541K
—
GA
01
—
2015540
PK
—
Enumeration date
07/16/2006
Last updated
06/03/2024
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