Organization
WAL-MART STORES EAST LP
Active
Other names
WALMART PHARMACY 10-4350
Organization subpart
No
Provider details
NPI number
Authorized official
SARAH LITTLE (DIRECTOR OF HEALTHCARE CONTRACTING)
(479) 277-2500
Entity
Organization
Contact information
Practice address
200 OLD FAIR GROUNDS WAY, KILMARNOCK, VA 22482-3871
(804) 435-6317
Mailing address
702 SW 8TH ST, BENTONVILLE, AR 72716-0445
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
3336C0003X
Community/Retail Pharmacy
Primary
0201004193
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1225222631
—
VA
05
—
1225222631DME
—
VA
01
—
2106310
PK
—
Enumeration date
08/29/2007
Last updated
08/21/2023
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