Organization
WAL-MART STORES EAST LP
Active
Other names
Walmart Pharmacy 10-4470
Organization subpart
No
Provider details
NPI number
Authorized official
SARAH LITTLE (DIRECTOR OF HEALTHCARE CONTRACTING)
(479) 277-2500
Entity
Organization
Contact information
Practice address
25145 DEMOTT DR, JOPLIN, MO 64801-6370
(417) 208-0118
(417) 208-0115
Mailing address
702 SW 8TH ST, BENTONVILLE, AR 72716-6209
(479) 204-8550
(479) 277-4331
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
3336C0003X
Community/Retail Pharmacy
Primary
2015044164
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2154935
PK
—
Enumeration date
09/28/2015
Last updated
10/21/2019
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