MEDICARE: WAL-MART STORES EAST LP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332B00000X	Durable Medical Equipment & Medical Supplies
2	3336C0003X	Community/Retail Pharmacy
3	333600000X	Pharmacy	PH30397	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	2164048	OTHER	PK

General Provider Information

NPI Number	:	1073060646
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WAL-MART STORES EAST LP

Provider Business Mailing Address
First Line	:	702 SW 8TH ST
Second Line	:
City	:	BENTONVILLE
State	:	AR
Zip	:	72716-0445
Country	:	US
Telephone Number	:	479-204-8550
Fax Number	:	479-277-4331

Provider Business Practice Location Address
First Line	:	16313 NEW INDEPENDENCE PKWY
Second Line	:
City	:	WINTER GARDEN
State	:	FL
Zip	:	34787-8113
Country	:	US
Telephone Number	:	407-554-0181
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR, CONTRACTING
Name	:	MATTHEW MCMULLIN
Credential	:
Telephone Number	:	479-371-8711

Provider Enumeration Date	:	09/01/2016
Last Update Date	:	11/06/2023

Similar Medicare Providers

1013920305 — DR. CAROL ANDREA STEWART-FRANCISCO
Practice Location Address:

16313 NEW INDEPENDENCE PKWY # 110
WINTER GARDEN, FL
34787-8113

Practice Phone: 407-593-4665
Practice Fax: 407-656-4591

1548913551 — MRS. JASMINE LEVETTE JARRETT NP-C
Practice Location Address:

16313 NEW INDEPENDENCE PKWY # 110
WINTER GARDEN, FL
34787-8113

Practice Phone: 407-593-4665
Practice Fax: 407-656-4591

1063891893 — MAURICIO BERRIO OROZCO NURSE PRACTITIONER
Practice Location Address:

16313 NEW INDEPENDENCE PKWY # 110
WINTER GARDEN, FL
34787-8113

Practice Phone: 407-593-4665
Practice Fax: 407-656-4591

1629582507 — CAMILLE DENEFIELD
Practice Location Address:

16313 NEW INDEPENDENCE PKWY
WINTER GARDEN, FL
34787-8113

Practice Phone: 407-554-0181
Practice Fax:

1871193243 — JENNIFER LEVANGIE
Practice Location Address:

16313 NEW INDEPENDENCE PKWY
WINTER GARDEN, FL
34787-8113

Practice Phone: 407-554-0181
Practice Fax:

1922609452 — EBONY DUCKWORTH HUMPHREY PHARM D
Practice Location Address:

16313 NEW INDEPENDENCE PKWY
WINTER GARDEN, FL
34787-8113

Practice Phone: 407-554-0181
Practice Fax:

Directions to “WAL-MART STORES EAST LP ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.