Provider Information for 1902823107
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WAL-MART STORES EAST LP
Other Names:Doing Business As:WALMART PHARMACY 10-0335Organization Subpart: NO
NPI: 1902823107
Last Updated: 2023-08-23
Certification Date: 2023-08-23
Certification Date: 2023-08-23
Details
| Name | Value | ||||||||||||||||
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| NPI | 1902823107 | ||||||||||||||||
| 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: 479-204-8550 | Fax:479-277-4331 | ||||||||||||||||
| Primary Practice Address | 2196 EMPORIUM DR JACKSON, TN 38305-6004 United States Phone: 731-668-1284 | Fax:731-668-1284 | ||||||||||||||||
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