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Provider Information for 1568004216


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WALMART INC

Other Names:  
Doing Business As: 
WALMART PHARMACY 10-5140

Organization Subpart: NO

NPI: 1568004216
Last Updated: 2023-08-30
Certification Date: 2023-08-30

Details

NameValue
NPI1568004216
Enumeration Date2019-10-15
NPI TypeNPI-2 Organization
StatusActive
Authorized Official Information Name: SARAH LITTLE
Title: Dir Healthcare Contracting
Phone: 4792772500
Mailing Address 702 SW 8TH ST
BENTONVILLE, AR 72716-0445
United States

Phone: 479-258-2115 | Fax:479-277-4331
 
Primary Practice Address 5500 GROSSMONT CENTER DR
LA MESA, CA 91942-3016
United States

Phone: 619-315-0002 | Fax:619-315-0003
 
Secondary Practice Address(es)
Health Information Exchange
Endpoint TypeEndpointEndpoint DescriptionUseContent TypeAffiliationEndpoint Location
CONNECT URL
https://esmd.abilitynetwork.com:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRRequest_Service
2.16.840.1.113883.3.667.2
CMS esMD eMDR Ability Network 100 N 6th St # A
Minneapolis, MN 55403-1505
United States
Other Identifiers
IssuerStateNumberOther Issuer
Taxonomy
Primary TaxonomySelected TaxonomyStateLicense Number
No 332B00000X - Durable Medical Equipment & Medical Supplies
Yes 333600000X - Pharmacy