Organization
WAL-MART STORES EAST LP
Active
Other names
WALMART PHARMACY 10-0161
Organization subpart
No
Provider details
NPI number
Authorized official
MATTHEW MCMULLIN (DIRECTOR CONTRACTING)
(479) 371-8711
Entity
Organization
Contact information
Practice address
180 VETERANS DR N, HUNTINGDON, TN 38344-6202
(731) 986-2888
(731) 986-4998
Mailing address
702 SW 8TH ST, BENTONVILLE, AR 72716-0445
(479) 204-8550
(479) 277-4331
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
C3024
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1454007
—
TN
01
—
2091839
PK
—
Enumeration date
07/16/2006
Last updated
12/01/2023
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