Organization
WAL-MART STORES EAST LP
Active
Other names
WalMart Pharmacy 10-4514
Organization subpart
No
Provider details
NPI number
Authorized official
SARAH LITTLE (DIRECTOR OF HEALTHCARE CONTRACTING)
(479) 277-2500
Entity
Organization
Contact information
Practice address
201 MARANTO MANOR DR, WINCHESTER, VA 22602-4807
(540) 868-5109
Mailing address
702 SW 8TH ST, BENTONVILLE, AR 72716-6209
(479) 277-1238
(479) 277-4331
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
3336C0003X
Community/Retail Pharmacy
Primary
0201004429
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1811277072
—
VA
01
—
2131610
PK
—
Enumeration date
08/19/2011
Last updated
08/29/2023
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