Organization
WAL-MART STORES EAST LP
Active
Other names
Walmart Pharmacy 10-2887
Organization subpart
No
Provider details
NPI number
Authorized official
SARAH LITTLE (DIRECTOR OF HEALTHCARE CONTRACTING)
(479) 277-2500
Entity
Organization
Contact information
Practice address
125 MARYPORT DR, MYRTLE BEACH, SC 29575-6513
(843) 232-0495
Mailing address
702 SW 8TH ST, BENTONVILLE, AR 72716-0445
(479) 277-2500
(479) 277-4331
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
3336C0003X
Community/Retail Pharmacy
Primary
15203
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2144419
PK
—
05
—
715203
—
SC
Enumeration date
02/14/2014
Last updated
08/30/2023
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