Organization
WAL-MART STORES EAST , LP
Active
Other names
Walmart Pharmacy 10-3062
Organization subpart
No
Provider details
NPI number
Authorized official
MATTHEW MCMULLIN (DIRECTOR)
(479) 371-8711
Entity
Organization
Contact information
Practice address
3536 W MOUNT VERNON ST, SPRINGFIELD, MO 65802-5207
(417) 616-2674
Mailing address
702 SW 8TH ST, BENTONVILLE, AR 72716-6209
(479) 277-1238
(479) 277-4331
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
3336C0003X
Community/Retail Pharmacy
Primary
2012034758
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1508115726
—
MO
01
—
2136760
PK
—
Enumeration date
09/04/2012
Last updated
05/30/2024
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