Organization
WAL-MART STORES EAST LP
Active
Other names
WALMART PHARMACY 10-4226
Organization subpart
No
Provider details
NPI number
Authorized official
SARAH LITTLE (DIRECTOR OF HEALTHCARE CONTRACTING)
(479) 277-2500
Entity
Organization
Contact information
Practice address
16773 RANKIN AVE, DUNLAP, TN 37327-7021
(423) 949-5056
(423) 949-2448
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
—
—
3336C0003X
Community/Retail Pharmacy
Primary
4353
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2095153
PK
—
05
—
466412
—
TN
Enumeration date
12/27/2006
Last updated
08/23/2023
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