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NPI Code Detail

MEDICARE: WAL-MART STORES EAST LP

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
1332B00000XDurable Medical Equipment & Medical Supplies
2333600000XPharmacy
33336C0003XCommunity/Retail Pharmacy27060NY

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
22063197OTHERPK
3MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1508883737
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 :
Fax Number :
Provider Business Practice Location Address
First Line : 135 FAIRGROUNDS MEMORIAL PKWY
Second Line :
City : ITHACA
State : NY
Zip : 14850-5362
Country : US
Telephone Number : 607-277-8126
Fax Number :
Authorized Official
Title or Position : DIRECTOR OF HEALTHCARE CONTRACTING
Name : SARAH LITTLE
Credential :
Telephone Number : 479-277-2500
Provider Enumeration Date : 07/16/2006
Last Update Date : 02/20/2017

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Practice Location Address:
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Practice Fax: 607-277-8613
1053633701 — KEVIN F FINCH R. PH.
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135 FAIRGROUNDS MEMORIAL PKWY
ITHACA, NY
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1841568979 — MS. GRETCHEN MARY KELLY PHARM.D
Practice Location Address:
135 FAIRGROUNDS MEMORIAL PKWY , ITHACA STORE#5240
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1508275736 — DASHAN OUYANG
Practice Location Address:
135 FAIRGROUNDS MEMORIAL PKWY
ITHACA, NY
14850-5362
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Practice Fax:

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

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