Provider Information for 1316349590
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WAL-MART STORES EAST LP
Other Names:Doing Business As:WALMART PHARMACY 10-2442Organization Subpart: NO
NPI: 1316349590
Last Updated: 2023-08-29
Certification Date: 2023-08-29
Certification Date: 2023-08-29
Details
| Name | Value | ||||||||||||||
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| NPI | 1316349590 | ||||||||||||||
| Enumeration Date | 2014-09-19 | ||||||||||||||
| 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: 479-277-1242 | Fax:479-277-4331 | ||||||||||||||
| Primary Practice Address | 5261 NE ANTIOCH RD KANSAS CITY, MO 64119-2646 United States Phone: 816-448-4002 | Fax:816-448-4631 | ||||||||||||||
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