Organization
WAL-MART STORES EAST LP
Active
Other names
WALMART PHARMACY 10-4223
Organization subpart
No
Provider details
NPI number
Authorized official
SARAH LITTLE (DIRECTOR OF HEALTHCARE CONTRACTING)
(479) 277-2500
Entity
Organization
Contact information
Practice address
2410 US HIGHWAY 411 S, MARYVILLE, TN 37801-8629
(865) 982-5102
(865) 982-2481
Mailing address
702 SW 8TH ST, BENTONVILLE, AR 72716-0445
(479) 204-8550
(479) 277-4331
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
3336C0003X
Community/Retail Pharmacy
Primary
4364
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1455191
—
TN
01
—
2095166
PK
—
Enumeration date
03/15/2007
Last updated
07/09/2025
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