Organization
WAL-MART STORES EAST LP
Active
Other names
WalMart Pharmacy 10-6394
Organization subpart
No
Provider details
NPI number
Authorized official
SARAH LITTLE (DIRECTOR OF HEALTHCARE CONTRACTING)
(479) 277-2500
Entity
Organization
Contact information
Practice address
6300 W BROWN DEER RD, BROWN DEER, WI 53223-2233
(414) 410-2551
(414) 410-2552
Mailing address
702 SW 8TH ST, BENTONVILLE, AR 72716-0445
(479) 258-2115
(479) 277-4331
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
3336C0003X
Community/Retail Pharmacy
Primary
9259-42
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1669882445
—
WI
01
—
2145742
PK
—
Enumeration date
05/02/2014
Last updated
08/30/2023
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