Organization
WAL-MART STORES EAST LP
Active
Other names
WalMart Pharmacy 10-5936
Organization subpart
No
Provider details
NPI number
Authorized official
SARAH LITTLE (DIRECTOR OF HEALTHCARE CONTRACTING)
(479) 277-2500
Entity
Organization
Contact information
Practice address
1500 CORNERSIDE BLVD STE B, VIENNA, VA 22182-2437
(571) 623-3307
Mailing address
702 SW 8TH ST, BENTONVILLE, AR 72716-0445
(479) 204-8550
(479) 277-4331
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
3336C0003X
Community/Retail Pharmacy
Primary
0201004528
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1942648472
—
VA
01
—
2140668
PK
—
Enumeration date
06/06/2013
Last updated
08/29/2023
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