OrganizationWal-Mart Stores East Lp(Wal-Mart Pharmacy 10-1481)PharmacySuppliersPractice Address209 Lakeshore Pkwy, Homewood, AL 35209-7105(205) 942-0977PECOS EnrollmentBased on the most recent information from CMS, provider Wal-Mart Stores East Lp does not have current enrollment records in PECOS.Part BMedicare Part BNot EnrolledHHAHome Health AgencyNot EnrolledDMEDurable Medical EquipmentNot EnrolledPMDPower Mobility DeviceNot EnrolledCMS last updated its PECOS records 5 days ago.Profile DetailsProvider ID1184641482Provider TypeOrganizationFull NameWal-Mart Stores East LpOther NameWal-Mart Pharmacy 10-1481SubpartNoEnumeration Date7/16/2006Last Updated8/30/2023Contact InformationPractice LocationPractice Address209 Lakeshore Pkwy, Homewood, AL 35209-7105Phone(205) 942-0977FaxUnlisted FaxMailing LocationMailing Address702 SW 8th St, Bentonville, AR 72716-0445PhoneUnlisted PhoneFaxUnlisted FaxAuthorized OfficialNameLittle, Sarah (Director Of Healthcare Contracting)Phone(479) 277-2500Provider TaxonomiesCodeDescriptionLicenseCode3336C0003XPrimaryDescriptionPharmacySuppliersLicense109934AlabamaCode332B00000XDescriptionDurable Medical Equipment & Medical SuppliesSuppliersLicenseUnlisted IssuerCode333600000XDescriptionPharmacySuppliersLicenseUnlisted IssuerProvider IdentifiersIDDescriptionIssuerID100003382DescriptionMedicaidIssuerUnlistedAlabamaID1992486DescriptionOtherIssuerPK