Organization
WAL-MART STORES EAST , LP
Active
Other names
WALMART PHARMACY 10-5692
Organization subpart
No
Provider details
NPI number
Authorized official
MATTHEW MCMULLIN (DIRECTOR)
(479) 371-8711
Entity
Organization
Contact information
Practice address
3150 W REPUBLIC RD, SPRINGFIELD, MO 65807-5420
(417) 520-3149
Mailing address
702 SW 8TH ST, BENTONVILLE, AR 72716-6209
(479) 277-1238
(479) 277-4331
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
3336C0003X
Community/Retail Pharmacy
Primary
2012013717
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2134316
PK
—
Enumeration date
03/12/2012
Last updated
05/29/2024
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