Organization
WAL-MART STORES EAST LP
Active
Other names
WAL-MART PHARMACY 10-1419
Organization subpart
No
Provider details
NPI number
Authorized official
SARAH LITTLE (DIRECTOR OF HEALTHCARE CONTRACTING)
(479) 277-2500
Entity
Organization
Contact information
Practice address
5311 COLDWATER RD, FORT WAYNE, IN 46825-5444
(260) 484-4528
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
60005057A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100081790
—
IN
05
—
100081790A
—
IN
01
—
2026975
PK
—
Enumeration date
07/16/2006
Last updated
08/30/2023
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