Organization
WAL-MART STORES EAST LP
Active
Other names
WalMart Pharmacy 10-5079
Organization subpart
No
Provider details
NPI number
Authorized official
SARAH LITTLE (DIRECTOR OF HEALTHCARE CONTRACTING)
(479) 277-2500
Entity
Organization
Contact information
Practice address
1617 E BEACH BLVD, PASS CHRISTIAN, MS 39571-4914
(228) 452-7890
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
08175/01.2
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
06756754
—
MS
01
—
2121921
PK
—
Enumeration date
08/25/2009
Last updated
08/30/2023
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