Organization
WAL-MART STORES EAST LP
Active
Other names
Walmart Pharmacy 10-5483
Organization subpart
No
Provider details
NPI number
Authorized official
SARAH LITTLE (DIRECTOR OF HEALTHCARE CONTRACTING)
(479) 277-2500
Entity
Organization
Contact information
Practice address
882 S STATE ROAD 135, GREENWOOD, IN 46143-9412
(317) 851-1103
(317) 851-1105
Mailing address
702 SW 8TH ST, BENTONVILLE, AR 72716-0445
(479) 204-1258
(479) 277-4331
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
3336C0003X
Community/Retail Pharmacy
Primary
60006454A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
201311390 A
—
IN
01
—
2150470
PK
—
Enumeration date
02/16/2015
Last updated
08/22/2023
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