Organization
WAL-MART STORES EAST LP
Active
Other names
WAL-MART PHARMACY 10-2576
Organization subpart
No
Provider details
NPI number
Authorized official
SARAH LITTLE (DIRECTOR OF HEALTHCARE CONTRACTING)
(479) 277-2500
Entity
Organization
Contact information
Practice address
100 NITRO MARKET PL, CROSS LANES, WV 25313-4401
(304) 769-0140
Mailing address
702 SW 8TH ST, BENTONVILLE, AR 72716-0445
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
MP0552219
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0141834000
—
WV
05
—
141834000
—
WV
01
—
2111370
PK
—
Enumeration date
07/18/2006
Last updated
08/28/2023
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