Provider Information for 1003833294
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WAL-MART STORES EAST LP
Other Names:Doing Business As:WALMART PHARMACY 10-1857Organization Subpart: NO
NPI: 1003833294
Last Updated: 2017-02-20
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Details
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NPI | 1003833294 | ||||||||||||||||
Enumeration Date | 2006-07-16 | ||||||||||||||||
NPI Type | NPI-2 Organization | ||||||||||||||||
Status | Active | ||||||||||||||||
Authorized Official Information | Name: SARAH LITTLE Title: Director of Healthcare Contracting Phone: 4792772500 | ||||||||||||||||
Mailing Address | 702 SW 8TH ST BENTONVILLE, AR 72716-0445 United States Phone: | Fax: | ||||||||||||||||
Primary Practice Address | 9303 MENTOR AVE MENTOR, OH 44060-6413 United States Phone: 440-974-3301 | Fax: | ||||||||||||||||
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