Organization
WAL-MART STORES EAST LP
Active
Organization
WAL-MART STORES EAST LP
Active
Parent organization
WAL-MART STORES INC
Other names
WAL-MART PHARMACY
Organization subpart
Yes
Provider details
NPI number
Legal business name
WAL-MART STORES INC
Authorized official
DIANNA PAINTER (PHY ENROLLMENT SPECIALIST)
(479) 277-1238
Entity
Organization
Contact information
Practice address
3501 CORTEZ RD W, BRADENTON, FL 34210-3104
(941) 727-1550
Mailing address
702 SW 8TH ST, BENTONVILLE, AR 72716-6209
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
PH16422
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
106590400
—
FL
01
—
1084918
NCPDP PROVIDER IDENTIFICATION NUMBER
—
Enumeration date
07/19/2006
Last updated
01/26/2009
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