Wal-Mart Stores East LP
Pharmacy, Community/Retail Pharmacy in Fort Wayne, IN. Organization (NPI-2).
NPI number1104843572
StatusActive
Last updated in NPPESAug 30, 2023
Details
- NPI
- 1104843572
- Entity type
- Organization (NPI-2)
- Legal business name
- Wal-Mart Stores East LP
- Organization subpart
- No
- Enumeration date
- Jul 16, 2006
- Certification date
- Aug 30, 2023
- Last updated
- Aug 30, 2023
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 3336C0003X | Pharmacy, Community/Retail Pharmacy | 60005739A | IN | Yes |
| 332B00000X | Durable Medical Equipment & Medical Supplies | – | – | |
| 333600000X | Pharmacy | – | – |
Other names
- Walmart Pharmacy 10-5025 (Doing Business As)
Practice location
10420 Maysville RdFort Wayne, IN 46835-9762
Phone 260-492-5799
Mailing address
702 Sw 8th StBentonville, AR 72716-0445
Authorized official
Sarah Little
Director Of Healthcare Contracting
4792772500
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