Organization
WAL-MART STORES EAST , LP
Active
Other names
Walmart Pharmacy 10-3745
Organization subpart
No
Provider details
NPI number
Authorized official
MATTHEW MCMULLIN (DIRECTOR)
(479) 371-8711
Entity
Organization
Contact information
Practice address
1840 MCKEEN PL, MONROE, LA 71201-4465
(318) 267-3617
(318) 267-3618
Mailing address
702 SW 8TH ST, BENTONVILLE, AR 72716-0445
(479) 204-8550
(479) 277-4331
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
PHY.007035-RC
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2149160
PK
—
05
—
2203479
—
LA
Enumeration date
10/07/2014
Last updated
05/30/2024
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