Organization
WAL-MART STORES EAST LP
Active
Other names
WALMART PHARMACY 10-5088
Organization subpart
No
Provider details
NPI number
Authorized official
SARAH LITTLE (DIRECTOR OF HEALTHCARE CONTRACTING)
(479) 277-2500
Entity
Organization
Contact information
Practice address
450 STEWART LN, TRIADELPHIA, WV 26059-1020
(304) 547-1950
Mailing address
702 SW 8TH ST, BENTONVILLE, AR 72716-0445
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
3336C0003X
Community/Retail Pharmacy
Primary
MP0552339
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2111630
PK
—
05
—
3810008651
—
WV
Enumeration date
10/12/2006
Last updated
08/30/2023
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