Organization
WAL-MART STORES EAST LP
Active
Other names
WAL-MART PHARMACY 10-2654
Organization subpart
No
Provider details
NPI number
Authorized official
SARAH LITTLE (DIRECTOR OF HEALTHCARE CONTRACTING)
(479) 277-2500
Entity
Organization
Contact information
Practice address
1650 EDMONTON RD, TOMPKINSVILLE, KY 42167-9403
(270) 487-0791
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
P06442
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2033016
PK
—
05
—
5400706700
—
KY
05
—
5403433500
—
KY
Enumeration date
07/16/2006
Last updated
08/28/2023
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