Organization
WAL-MART STORES EAST LP
Active
Other names
WALMART PHARMACY 10-4523
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 BLANKENBAKER PKWY, LOUISVILLE, KY 40243-1877
(502) 244-5455
Mailing address
702 SW 8TH ST, BENTONVILLE, AR 72716-0445
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
3336C0003X
Community/Retail Pharmacy
Primary
P07197
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2034945
PK
—
05
—
7100005290
—
KY
05
—
7100037560
—
KY
Enumeration date
05/31/2007
Last updated
02/16/2017
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