# WAL-MART STORES EAST LP

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- **Entity:** Organization
- **Status:** Active
- **Other names:** WAL-MART PHARMACY 10-1967
- **Organization subpart:** No

## Provider details

- **NPI number:** 1194742486
- **Authorized official:** KIMBERLY CANONIC (SENIOR DIRECTOR, ENROLLMENT)
- **Authorized official phone:** (480) 277-6348

## Contact information

- **Practice address:** 1105 BOSTON RD, SPRINGFIELD, MA 01119-1333
- **Practice address phone:** (413) 782-6897
- **Mailing address:** 702 SW 8TH ST, BENTONVILLE, AR 72716-0445

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 332B00000X | Durable Medical Equipment & Medical Supplies | — | NULL | — |
| 333600000X | Pharmacy | — | NULL | — |
| 3336C0003X | Community/Retail Pharmacy | CS2737 | MA | Yes |

## Other

- **Enumeration date:** 07/16/2006
- **Last updated:** 06/09/2025

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 0446084 | — | MA |
| 01 | — | 2037247 | PK | — |
| 05 | — | 446084 | — | MA |