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Organization
WAL-MART STORES EAST LP
Active
Organization
WAL-MART STORES EAST LP
Active
Other names
WAL-MART PHARMACY 10-1967
Organization subpart
No
Provider details
NPI number
Authorized official
KIMBERLY CANONIC (SENIOR DIRECTOR, ENROLLMENT)
(480) 277-6348
Entity
Organization
Contact information
Practice address
1105 BOSTON RD, SPRINGFIELD, MA 01119-1333
(413) 782-6897
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
CS2737
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0446084
—
MA
01
—
2037247
PK
—
05
—
446084
—
MA
Enumeration date
07/16/2006
Last updated
06/09/2025
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