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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
23336C0003XCommunity/Retail Pharmacy09991NC

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
12067180OTHERPK

General Provider Information

NPI Number : 1831375229
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 : 1205 EASTERN AVE
Second Line :
City : NASHVILLE
State : NC
Zip : 27856-1814
Country : US
Telephone Number : 252-459-0020
Fax Number :
Authorized Official
Title or Position : DIRECTOR OF HEALTHCARE CONTRACTING
Name : SARAH LITTLE
Credential :
Telephone Number : 479-277-2500
Provider Enumeration Date : 01/15/2008
Last Update Date : 08/23/2023

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

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