Organization
WAL-MART STORES EAST LP
Active
Other names
Wal-Mart Pharmacy 10-3059
Organization subpart
No
Provider details
NPI number
Authorized official
SARAH LITTLE (DIRECTOR OF HEALTHCARE CONTRACTING)
(479) 277-2500
Entity
Organization
Contact information
Practice address
244 FEATHER LN, CANTON, MS 39046-9793
(601) 859-3535
Mailing address
702 SW 8TH ST, BENTONVILLE, AR 72716-0445
(479) 273-4000
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
3336C0003X
Community/Retail Pharmacy
Primary
12656/1.2
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
04150876
—
MS
01
—
2142654
PK
—
Enumeration date
10/08/2013
Last updated
08/30/2023
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