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
Update your record
If you believe information in your NPPES record is inaccurate, or if you wish to update or deactivate your NPI, you can do so directly with CMS at https://nppes.cms.hhs.gov.
About Stedi
Stedi is the only programmable healthcare clearinghouse. You can use Stedi's APIs to process eligibility checks, claims, remits, and more.
Sign up