Organization
WAL-MART STORES EAST LP
Active
Other names
WALMART PHARMACY 10-4615
Organization subpart
No
Provider details
NPI number
Authorized official
SARAH LITTLE (DIRECTOR OF HEALTHCARE CONTRACTING)
(479) 277-2500
Entity
Organization
Contact information
Practice address
12200 S WACO AVE, GLENPOOL, OK 74033-5655
(918) 299-8030
Mailing address
702 SW 8TH ST, MAILSTOP 0445, BENTONVILLE, AR 72716-6209
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
3336C0003X
Community/Retail Pharmacy
Primary
2-5298
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100240050N
—
OK
01
—
2077199
PK
—
Enumeration date
01/16/2008
Last updated
08/29/2023
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