Organization
MC MEDICAL LLC
Active
Other names
Walmart Health
Organization subpart
No
Provider details
NPI number
Authorized official
SOUJANYA PULLURU (OWNER)
(630) 545-4046
Entity
Organization
Contact information
Practice address
10991 SAN JOSE BLVD UNIT 100, JACKSONVILLE, FL 32223-6675
(904) 380-3055
Mailing address
702 SW 8TH ST # MS 0445, BENTONVILLE, AR 72716-0445
(479) 258-2080
Taxonomy
Speciality
Code
Description
License number
State
208D00000X
General Practice Physician
Primary
—
—
363L00000X
Nurse Practitioner
—
—
Other
Enumeration date
11/30/2022
Last updated
11/30/2022
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