Organization
WAL-MART STORES EAST LP
Active
Other names
WAL-MART PHARMACY 10-3215
Organization subpart
No
Provider details
NPI number
Authorized official
SARAH LITTLE (DIRECTOR OF HEALTHCARE CONTRACTING)
(479) 277-2500
Entity
Organization
Contact information
Practice address
5605 UNIVERSITY TOWN CENTRE DR, MORGANTOWN, WV 26501-2473
(304) 598-3404
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
MP0552336
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2111627
PK
—
05
—
3810007297
—
WV
Enumeration date
10/03/2006
Last updated
08/30/2023
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