Organization
WAL-MART STORES EAST LP
Active
Other names
WAL-MART PHARMACY 10-1729
Organization subpart
No
Provider details
NPI number
Authorized official
SARAH LITTLE (DIRECTOR OF HEALTHCARE CONTRACTING)
(479) 277-2500
Entity
Organization
Contact information
Practice address
4200 WESTERN AVE, CONNERSVILLE, IN 47331-3493
(765) 825-7664
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
60005079
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100295630
—
IN
05
—
100295630A
—
IN
01
—
2027167
PK
—
Enumeration date
07/16/2006
Last updated
08/23/2023
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