Organization
WAL-MART STORES EAST LP
Active
Organization
WAL-MART STORES EAST LP
Active
Other names
Walmart Pharmacy 10-7307
Organization subpart
No
Provider details
NPI number
Authorized official
SARAH LITTLE (DIRECTOR OF HEALTHCARE CONTRACTING)
(479) 277-2500
Entity
Organization
Contact information
Practice address
4536 53RD AVE E, BRADENTON, FL 34203-4112
(941) 213-6910
(941) 213-6909
Mailing address
702 SW 8TH ST, MAILSTOP 0445, 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
PH29938
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
017095200
—
FL
05
—
017095201
—
FL
01
—
2158158
PK
—
Enumeration date
02/15/2016
Last updated
07/21/2022
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