Organization
WAL-MART STORES EAST LP
Active
Other names
WALMART PHARMACY 10-0143
Organization subpart
No
Provider details
NPI number
Authorized official
MATTHEW MCMULLIN (DIRECTOR, CONTRACTING)
(479) 371-8711
Entity
Organization
Contact information
Practice address
310 W 5TH ST, BENTON, KY 42025-1102
(270) 527-3597
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
PO2570
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2031870
PK
—
05
—
5400719000
—
KY
05
—
5402952500
—
KY
Enumeration date
07/16/2006
Last updated
12/01/2023
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