Organization
WAL-MART STORES EAST LP
Active
Organization
WAL-MART STORES EAST LP
Active
Other names
WalMart Pharmacy 10-4638
Organization subpart
No
Provider details
NPI number
Authorized official
SARAH LITTLE (DIRECTOR OF HEALTHCARE CONTRACTING)
(479) 277-2500
Entity
Organization
Contact information
Practice address
135 STONERIDGE DR N, RUCKERSVILLE, VA 22968-3088
(434) 990-6003
Mailing address
702 SW 8TH ST, BENTONVILLE, AR 72716-0445
(479) 277-1238
(479) 277-4331
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
3336C0003X
Community/Retail Pharmacy
Primary
0201004352
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1871804286
—
VA
05
—
1871804286 DME
—
VA
01
—
2125809
PK
—
Enumeration date
06/30/2010
Last updated
08/29/2023
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