Organization
WAL-MART STORES EAST LP
Active
Other names
WALMART PHARMACY 10-4379
Organization subpart
No
Provider details
NPI number
Authorized official
SARAH LITTLE (DIRECTOR OF HEALTHCARE CONTRACTING)
(479) 277-2500
Entity
Organization
Contact information
Practice address
1326 BUSH RIVER RD, COLUMBIA, SC 29210-6804
(803) 750-3284
Mailing address
702 SW 8TH ST, BENTONVILLE, AR 72716-0445
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
3336C0003X
Community/Retail Pharmacy
Primary
9287
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2093333
PK
—
05
—
792872
—
SC
05
—
792878
—
SC
05
—
DE3087
—
SC
Enumeration date
04/19/2007
Last updated
02/16/2017
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