Wal-Mart Stores East LP
Pharmacy, Community/Retail Pharmacy in South Bend, IN. Organization (NPI-2).
NPI number1104843325
StatusActive
Last updated in NPPESFeb 16, 2017
Details
- NPI
- 1104843325
- Entity type
- Organization (NPI-2)
- Legal business name
- Wal-Mart Stores East LP
- Organization subpart
- No
- Enumeration date
- Jul 16, 2006
- Last updated
- Feb 16, 2017
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 3336C0003X | Pharmacy, Community/Retail Pharmacy | 60005426A | IN | Yes |
| 332B00000X | Durable Medical Equipment & Medical Supplies | – | – | |
| 333600000X | Pharmacy | – | – |
Other names
- Wal-Mart Pharmacy 10-2680 (Doing Business As)
Practice location
3701 Portage AveSouth Bend, IN 46628-6098
Phone 574-243-5849
Mailing address
702 Sw 8th StBentonville, AR 72716-0445
Authorized official
Sarah Little
Director Of Healthcare Contracting
4792772500
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