Organization
WAL-MART STORES EAST LP
Active
Other names
WAL-MART PHARMACY 10-2819
Organization subpart
No
Provider details
NPI number
Authorized official
SARAH LITTLE (DIRECTOR OF HEALTHCARE CONTRACTING)
(479) 277-2500
Entity
Organization
Contact information
Practice address
2100 N MAIN ST, BLUFFTON, IN 46714-1185
(260) 824-0546
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
60005495A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200260000
—
IN
05
—
200260000A
—
IN
01
—
2024263
PK
—
Enumeration date
07/16/2006
Last updated
08/23/2023
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