Organization

Wal-mart Stores East Lp

May also be knows as Walmart Pharmacy 10-0130

Community/Retail Pharmacy in Muskogee, OK(View on Map)

Legal Business Name

Wal-mart Stores East Lp

Also Known As

Walmart Pharmacy 10-0130

NPI Number

1407873524

NPI Type

Organization

Enumeration Date

07/16/2006

Specialties

(Taxonomies)

Code

3336C0003X
332B00000X
333600000X

Primary Taxonomy

Yes
No
No

Licenses

State

Oklahoma

License Number

44861

Contact
Information

Purpose

Mailing
Location

Address

702 SW 8TH ST
1000 W SHAWNEE ST

City

Bentonville
Muskogee

State

AR
OK

Postal Code

72716-0445
74401-3509

Country

US
US

Telephone Number

N/A
(918) 687-1231

Authorized Official

Name

Matthew Mcmullin

Title or Position

DIRECTOR, CONTRACTING

Telephone Number

(479) 371-8711

Identifiers

Identifier

100238970A
2074058

Identifier State

OK
Unknown

Identifier Issuer

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 St Ste 900AMinneapolis, MN554031516US

Provider data last refreshed from NPPES NPI registry on 11/19/2024

Data last updated by provider on 11/06/2023

Provider Address

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