Organization
WAL-MART STORES EAST LP
Active
Other names
WALMART PHARMACY 10-2727
Organization subpart
No
Provider details
NPI number
Authorized official
MATT MCMULLIN (DIRECTOR OF HEALTHCARE CONTRACTING)
(479) 371-8711
Entity
Organization
Contact information
Practice address
33501 S DIXIE HWY, FLORIDA CITY, FL 33034-5628
(305) 242-8787
(305) 242-8787
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
PH16923
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
021716600
—
FL
01
—
2006586
PK
—
05
—
2176600
—
FL
Enumeration date
07/16/2006
Last updated
08/29/2023
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