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Organization
WAL-MART STORES EAST LP
Active
Organization
WAL-MART STORES EAST LP
Active
Other names
WAL-MART PHARMACY 10-1970
Organization subpart
No
Provider details
NPI number
Authorized official
KIMBERLY CANONIC (SENIOR DIRECTOR, ENROLLMENT)
(480) 277-6348
Entity
Organization
Contact information
Practice address
280 WASHINGTON ST, HUDSON, MA 01749-2735
(978) 568-3377
Mailing address
702 SW 8TH ST, BENTONVILLE, AR 72716-0445
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
NULL
333600000X
Pharmacy
—
NULL
3336C0003X
Community/Retail Pharmacy
Primary
CS2743
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0446092
—
MA
01
—
2037270
PK
—
05
—
446092
—
MA
Enumeration date
07/16/2006
Last updated
06/09/2025
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