Provider Information for 1922025139
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WAL-MART STORES EAST LP
Other Names:Doing Business As:WAL-MART PHARMACY 10-1639Organization Subpart: NO
NPI: 1922025139
Last Updated: 2017-02-28
Certification Date:
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Details
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NPI | 1922025139 | ||||||||||||||||
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 | 2395 MAIN ST ROCHESTER, IN 46975-9137 United States Phone: 574-223-9482 | Fax: | ||||||||||||||||
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