Organization
WAL-MART STORES EAST LP
Active
Other names
WAL-MART PHARMACY 10-2047
Organization subpart
No
Provider details
NPI number
Authorized official
SARAH LITTLE (SENIOR DIRECTOR, ENROLLMENT)
(479) 277-2500
Entity
Organization
Contact information
Practice address
1573 MAIN ST, PALMYRA, ME 04965-3236
(207) 368-4401
(207) 368-7709
Mailing address
702 SW 8TH ST, BENTONVILLE, AR 72716-0445
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
PH50001136
ME
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
187470004
—
ME
01
—
2036841
PK
—
05
—
999010097
—
ME
Enumeration date
07/16/2006
Last updated
06/05/2025
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