Organization
WAL-MART STORES EAST LP
Active
Other names
WALMART PHARMACY 10-0693
Organization subpart
No
Provider details
NPI number
Authorized official
SARAH LITTLE (DIRECTOR OF HEALTHCARE CONTRACTING)
(479) 277-2500
Entity
Organization
Contact information
Practice address
1589 KENTUCKY HIGHWAY 15 S, JACKSON, KY 41339-8604
(606) 666-2622
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
PO2412
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2031742
PK
—
05
—
5400655600
—
KY
05
—
5402749500
—
KY
05
—
9008251
—
KY
Enumeration date
07/17/2006
Last updated
08/24/2023
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