Organization
WAL-MART STORES EAST LP
Active
Other names
Walmart Pharmacy 10-0154
Organization subpart
No
Provider details
NPI number
Authorized official
MATTHEW MCMULLIN (DIRECTOR, CONTRACTING)
(479) 371-8711
Entity
Organization
Contact information
Practice address
16032 15 MILE BLVD, ABINGDON, VA 24211-1106
(276) 619-5748
(276) 619-8331
Mailing address
702 SW 8TH ST, MAILSTOP 0445, BENTONVILLE, AR 72716-0445
(479) 204-8550
(479) 277-4331
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
333600000X
Pharmacy
Primary
0201004741
VA
3336C0003X
Community/Retail Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1396291647
—
VA
01
—
2164040
PK
—
Enumeration date
08/28/2016
Last updated
12/01/2023
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