Organization
WAL-MART STORES EAST LP
Active
Other names
Walmart Pharmacy 10-3415
Organization subpart
No
Provider details
NPI number
Authorized official
SARAH LITTLE (DIRECTOR OF HEALTHCARE CONTRACTING)
(479) 277-2500
Entity
Organization
Contact information
Practice address
41232 US HIGHWAY 19 N, TARPON SPRINGS, FL 34689-5106
(727) 940-9295
Mailing address
702 SW 8TH ST, BENTONVILLE, AR 72716-6209
(479) 277-1238
(479) 277-4331
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
3336C0003X
Community/Retail Pharmacy
Primary
PH26296
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
006733100
—
FL
01
—
2135545
PK
—
Enumeration date
05/31/2012
Last updated
02/15/2017
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