Organization
WALMART INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MATTHEW MCMULLIN (DIRECTOR, CONTRACTOR)
(479) 371-8711
Entity
Organization
Contact information
Practice address
3700 E HWY 18, BLYTHEVILLE, AR 72315-6881
(870) 763-1013
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
AR12445
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100870407
—
AR
01
—
1994232
PK
—
Enumeration date
07/16/2006
Last updated
11/06/2023
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