Organization
WAL-MART STORES EAST LP
Active
Other names
Walmart Pharmacy 10-5671
Organization subpart
No
Provider details
NPI number
Authorized official
SARAH LITTLE (DIRECTOR OF HEALTHCARE CONTRACTING)
(479) 277-2500
Entity
Organization
Contact information
Practice address
13600 SW 288TH ST, HOMESTEAD, FL 33033-1905
(305) 910-2965
Mailing address
702 SW 8TH ST, BENTONVILLE, AR 72716-0445
(479) 277-2500
(479) 277-4331
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
3336C0003X
Community/Retail Pharmacy
Primary
PS28223
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
012125000
—
FL
05
—
012125001 DME
—
FL
01
—
2144759
PK
—
Enumeration date
02/14/2014
Last updated
08/30/2023
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