Organization
WAL-MART STORES EAST LP
Active
Other names
WALMART PHARMACY 10-0882
Organization subpart
No
Provider details
NPI number
Authorized official
SARAH LITTLE (DIRECTOR OF HEALTHCARE CONTRACTING)
(479) 277-2500
Entity
Organization
Contact information
Practice address
38020 US HIGHWAY 18, PRAIRIE DU CHIEN, WI 53821-8206
(608) 326-5103
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
8128042
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2114576
PK
—
05
—
33058500
—
WI
Enumeration date
07/16/2006
Last updated
02/15/2017
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