Organization
WAL-MART STORES EAST LP
Active
Other names
WAL-MART PHARMACY 10-1767
Organization subpart
No
Provider details
NPI number
Authorized official
SARAH LITTLE (DIRECTOR OF HEALTHCARE CONTRACTING)
(479) 277-2500
Entity
Organization
Contact information
Practice address
4540 MAIN ST, SHALLOTTE, NC 28470-4446
(910) 754-2885
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
08008
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0105221
—
NC
05
—
105221
—
NC
01
—
2070365
PK
—
05
—
7704115
—
NC
Enumeration date
07/18/2006
Last updated
08/23/2023
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