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Organization

WAL-MART STORES EAST LP

Active
Other names
Wal-Mart Pharmacy 10-4612
Organization subpart
No

Provider details

NPI number
Authorized official
SARAH LITTLE (DIRECTOR OF HEALTHCARE CONTRACTING)
(479) 277-2500
Entity
Organization

Contact information

Practice address
1800 TILDEN RIDGE DR, HAMBURG, PA 19526-8181
(610) 562-4580
Mailing address
702 SW 8TH ST, BENTONVILLE, AR 72716-6209
(479) 277-1238
(479) 277-4331

Taxonomy

Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
3336C0003X
Community/Retail Pharmacy
Primary
PP482115
PA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
100745531288
PA
01
2128352
PK
Enumeration date
01/03/2011
Last updated
08/29/2023
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