Organization
WAL-MART STORES EAST LP
Active
Other names
WAL-MART PHARMACY 10-2795
Organization subpart
No
Provider details
NPI number
Authorized official
SARAH LITTLE (DIRECTOR OF HEALTHCARE CONTRACTING)
(479) 277-2500
Entity
Organization
Contact information
Practice address
145 HILL CARTER PKWY, ASHLAND, VA 23005-2327
(804) 798-3112
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
0201003919
VA
3336S0011X
Specialty Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
010001722
—
VA
05
—
10001722
—
VA
01
—
2105380
PK
—
Enumeration date
07/16/2006
Last updated
08/29/2023
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