Organization
WAL-MART STORES EAST LP
Active
Other names
Walmart Pharmacy 10-5090
Organization subpart
No
Provider details
NPI number
Authorized official
SARAH LITTLE (DIRECTOR OF HEALTHCARE CONTRACTING)
(479) 277-2500
Entity
Organization
Contact information
Practice address
1415 LAWRENCE DR, DE PERE, WI 54115-3927
(920) 336-7168
(920) 336-7586
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
—
—
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
8315-42
WI
3336S0011X
Specialty Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2110078
PK
—
05
—
33270200
—
WI
Enumeration date
07/16/2006
Last updated
04/15/2024
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