Organization
WAL-MART STORES EAST , LP
Active
Other names
WAL-MART PHARMACY 10-2909
Organization subpart
No
Provider details
NPI number
Authorized official
MATTHEW MCMULLIN (DIRECTOR)
(479) 371-8711
Entity
Organization
Contact information
Practice address
961 E COLUMBUS AVE, CORRY, PA 16407-9163
(814) 663-7065
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
PP481128
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1007455310102
—
PA
01
—
2085896
PK
—
Enumeration date
07/18/2006
Last updated
06/04/2024
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