Organization
WAL-MART STORES EAST LP
Active
Other names
WALMART PHARMACY 10-0164
Organization subpart
No
Provider details
NPI number
Authorized official
MATTHEW MCMULLIN (DIRECTOR, CONTRACTING)
(479) 371-8711
Entity
Organization
Contact information
Practice address
100 MCCORD RD, PONTOTOC, MS 38863-6245
(662) 489-5421
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
01770
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
05532585
—
MS
01
—
2044827
PK
—
05
—
5532585
—
MS
Enumeration date
07/16/2006
Last updated
12/01/2023
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