Organization
WAL-MART STORES EAST , LP
Active
Other names
WAL-MART PHARMACY 10-2640
Organization subpart
No
Provider details
NPI number
Authorized official
MATTHEW MCMULLIN (DIRECTOR)
(479) 371-8711
Entity
Organization
Contact information
Practice address
450 HIGHLAND AVE, SALEM, MA 01970-1765
(978) 825-0845
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
CS2813
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0447013
—
MA
01
—
2038379
PK
—
05
—
447013
—
MA
Enumeration date
07/16/2006
Last updated
05/29/2024
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