Organization
WAL-MART STORES EAST , LP
Active
Other names
Walmart Pharmacy 10-7294
Organization subpart
No
Provider details
NPI number
Authorized official
MATTHEW MCMULLIN (DIRECTOR)
(479) 371-8711
Entity
Organization
Contact information
Practice address
3651 CLASSEN BLVD, NORMAN, OK 73071-1556
(405) 515-7023
(405) 515-7013
Mailing address
702 SW 8TH ST, BENTONVILLE, AR 72716-0445
(479) 204-8550
(479) 277-4331
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
7-7573
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100231610D
—
OK
01
—
2158817
PK
—
Enumeration date
02/29/2016
Last updated
06/03/2024
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