Organization
WAL-MART STORES EAST LP
Active
Other names
WALMART PHARMACY 10-0009
Organization subpart
No
Provider details
NPI number
Authorized official
MATTHEW MCMULLIN (DIRECTOR, CONTRACTING)
(479) 371-8711
Entity
Organization
Contact information
Practice address
1303 S MAIN ST, SIKESTON, MO 63801-9360
(573) 471-6775
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
2002009525
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2050233
PK
—
05
—
601371628
—
MO
Enumeration date
07/16/2006
Last updated
11/06/2023
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