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Organization
WAL-MART STORES EAST LP
Active
Organization
WAL-MART STORES EAST LP
Active
Other names
WalMart Pharmacy 10-4403
Organization subpart
No
Provider details
NPI number
Authorized official
KIMBERLY CANONIC (SENIOR DIRECTOR, ENROLLMENT)
(480) 853-0515
Entity
Organization
Contact information
Practice address
24 QUAKER RDG, QUEENSBURY, NY 12804-1556
(518) 761-4058
Mailing address
702 SW 8TH ST, BENTONVILLE, AR 72716-6209
(479) 277-1238
(479) 277-4331
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
3336C0003X
Community/Retail Pharmacy
Primary
030863
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
04432959
—
NY
01
—
2131167
PK
—
Enumeration date
07/20/2011
Last updated
07/10/2025
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