Organization
WAL-MART STORES EAST LP
Active
Other names
WalMart Pharmacy 10-5845
Organization subpart
No
Provider details
NPI number
Authorized official
MATT MCMULLIN (DIRECTOR OF HEALTHCARE CONTRACTING)
(793) 718-7114
Entity
Organization
Contact information
Practice address
1300 JOHN SIMS PKWY E, NICEVILLE, FL 32578-2208
(850) 839-3124
(850) 389-3014
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
PH25190
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
003180500
—
FL
01
—
2127457
PK
—
Enumeration date
10/27/2010
Last updated
08/29/2023
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