Organization
WAL-MART STORES EAST LP
Active
Other names
WAL-MART PHARMACY 10-1278
Organization subpart
No
Provider details
NPI number
Authorized official
SARAH LITTLE (DIRECTOR OF HEALTHCARE CONTRACTING)
(479) 277-2500
Entity
Organization
Contact information
Practice address
1506 FIR ST, PERRY, OK 73077-5004
(580) 336-4117
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
564044
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100244310A
—
OK
01
—
2074928
PK
—
Enumeration date
07/16/2006
Last updated
02/16/2017
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