Organization
WALMART INC.
Active
Other names
WALMART PHARMACY 10-0042
Organization subpart
No
Provider details
NPI number
Authorized official
MATTHEW MCMULLIN (DIRECTOR, COTRACTING)
(479) 371-8711
Entity
Organization
Contact information
Practice address
1863 CR 5300, COFFEYVILLE, KS 67337-8301
(620) 251-5528
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
2-10290
KS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100432940A
—
KS
01
—
2032065
PK
—
05
—
6010831822
—
KS
Enumeration date
07/16/2006
Last updated
11/06/2023
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