Organization
WAL-MART STORES EAST LP
Active
Other names
Walmart Pharmacy 10-2756
Organization subpart
No
Provider details
NPI number
Authorized official
SARAH LITTLE (DIRECTOR OF HEALTHCARE CONTRACTING)
(479) 277-2500
Entity
Organization
Contact information
Practice address
2421 MONOCACY BLVD, FREDERICK, MD 21701-3275
(301) 644-2449
(301) 644-2451
Mailing address
702 SW 8TH ST, BENTONVILLE, AR 72716-0445
(479) 258-6180
(479) 277-4331
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
P02681
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2037381
PK
—
05
—
407350900
—
MD
Enumeration date
07/16/2006
Last updated
08/29/2023
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