Organization
WAL-MART STORES EAST LP
Active
Other names
WAL-MART PHARMACY 10-2821
Organization subpart
No
Provider details
NPI number
Authorized official
MATT MCMULLIN (DIRECTOR OF HEALTHCARE CONTRACTING)
(479) 371-8711
Entity
Organization
Contact information
Practice address
2410 SHEILA LN, RICHMOND, VA 23225-2041
(804) 320-0099
(804) 320-0099
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
0201003677
VA
3336S0011X
Specialty Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
008508097
—
VA
01
—
2104695
PK
—
05
—
8508097
—
VA
Enumeration date
07/16/2006
Last updated
06/25/2024
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