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Organization
WAL-MART STORES EAST, LP
Active
Organization
WAL-MART STORES EAST, LP
Active
Other names
WALMART PHARMACY 10-1176
Organization subpart
No
Provider details
NPI number
Authorized official
KIMBERLY CANONIC (DIRECTOR)
(480) 853-0515
Entity
Organization
Contact information
Practice address
2600 STATE HWY 138, WALMART PHARMACY 10-1176, STROUGHTON, WI 53589-3701
(608) 873-9262
(608) 873-9780
Mailing address
1 CUSTOMER DR, MS 0445, 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
9444-42
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2114776
PK
—
05
—
33155500
—
WI
Enumeration date
07/18/2006
Last updated
04/27/2026
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