Wal-mart Stores East Lp
May also be knows as Walmart Pharmacy 10-5076
Community/Retail Pharmacy in Brewer, ME(View on Map)
Legal Business Name
Wal-mart Stores East Lp
Also Known As
Walmart Pharmacy 10-5076
NPI Number
1275550543
NPI Type
Organization
Enumeration Date
07/16/2006
Specialties
(Taxonomies)Code
3336C0003X
332B00000X
333600000X
Primary Taxonomy
Yes
No
No
Licenses
State
Maine
License Number
PH50001172
Contact
Information
Purpose
Mailing
Location
Address
702 SW 8TH ST
24 WALTON DR
City
Bentonville
Brewer
State
AR
ME
Postal Code
72716-0445
04412-1001
Country
US
US
Telephone Number
N/A
(207) 989-6174
Authorized Official
Name
Sarah Little
Title or Position
DIRECTOR OF HEALTHCARE CONTRACTING
Telephone Number
(479) 277-2500
Identifiers
Identifier
999111041
187470023
2037561
Identifier State
ME
ME
Unknown
Identifier Issuer
Unknown
Unknown
PK
Health Information Exchange
Endpoint Type
CONNECT
Endpoint
https://esmd.abilitynetwork.com:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRRequest_Service
Endpoint Description
2.16.840.1.113883.3.667.2
Use
Other
Content Type
Unknown
Affiliation
Y
Endpoint Location
Ability Network100 N 6th Stst #900aMinneapolis, ID55043US
Provider data last refreshed from NPPES NPI registry on 11/19/2024
Data last updated by provider on 08/30/2023
Provider Address
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