Organization
WAL-MART STORES EAST LP
Active
Parent organization
WAL-MART STORES INC
Other names
WAL-MART PHARMACY
Organization subpart
Yes
Provider details
NPI number
Legal business name
WAL-MART STORES INC
Authorized official
DIANNA PAINTER (PHY ENROLLMENT SPECIALIST)
(479) 277-1238
Entity
Organization
Contact information
Practice address
9920 E 30TH ST, INDIANAPOLIS, IN 46229-3610
(317) 895-6016
Mailing address
702 SW 8TH ST, BENTONVILLE, AR 72716-6209
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
60005852A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1537200
NCPDP PROVIDER IDENTIFICATION NUMBER
—
05
—
200466880B
—
IN
Enumeration date
07/16/2006
Last updated
01/26/2009
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