Organization
WAL-MART STORES EAST LP
Active
Other names
WalMart Pharmacy 10-5667
Organization subpart
No
Provider details
NPI number
Authorized official
SARAH LITTLE (DIRECTOR OF HEALTHCARE CONTRACTING)
(479) 277-2500
Entity
Organization
Contact information
Practice address
222 N CHICAGO AVE, SOUTH MILWAUKEE, WI 53172-1241
(414) 501-1122
(414) 501-1125
Mailing address
702 SW 8TH ST, BENTONVILLE, AR 72716-0445
(479) 204-8741
(479) 277-4331
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
3336C0003X
Community/Retail Pharmacy
Primary
9188-42
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1760722680
—
WI
01
—
2139280
PK
—
Enumeration date
03/01/2013
Last updated
08/30/2023
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