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Organization

WAL-MART STORES EAST LP

Active
Other names
WAL-MART PHARMACY 10-2682
Organization subpart
No

Provider details

NPI number
Authorized official
SARAH LITTLE (DIRECTOR OF HEALTHCARE CONTRACTING)
(479) 277-2500
Entity
Organization

Contact information

Practice address
282 BERLIN MALL RD STE 1, BERLIN, VT 05602-8493
(802) 229-8049
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
380003298
VT

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
01006555
VT
05
1006555
VT
01
2101632
PK
Enumeration date
07/16/2006
Last updated
08/29/2023
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