Provider Information for 1932592052
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WAL-MART STORES EAST LP
Other Names:Doing Business As:WALMART PHARMACY 10-6531Organization Subpart: NO
NPI: 1932592052
Last Updated: 2023-08-29
Certification Date: 2023-08-29
Certification Date: 2023-08-29
Details
| Name | Value | ||||||||||||||
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| NPI | 1932592052 | ||||||||||||||
| Enumeration Date | 2015-03-13 | ||||||||||||||
| 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 MS 0445 BENTONVILLE, AR 72716-0445 United States Phone: 479-277-2500 | Fax:479-277-4331 | ||||||||||||||
| Primary Practice Address | 9301 PINE FOREST RD PENSACOLA, FL 32534-9349 United States Phone: 850-483-6009 | Fax:850-483-6012 | ||||||||||||||
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