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Organization
WAL-MART STORES EAST LP
Active
Organization
WAL-MART STORES EAST LP
Active
Other names
WALMART PHARMACY 10-5202
Organization subpart
No
Provider details
NPI number
Authorized official
KIMBERLY CANONIC (SENIOR DIRECTOR, ENROLLMENT)
(480) 853-0515
Entity
Organization
Contact information
Practice address
85 CROOKED HILL RD, COMMACK, NY 11725-5407
(631) 864-1671
Mailing address
702 SW 8TH ST, BENTONVILLE, AR 72716-0445
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
3336C0003X
Community/Retail Pharmacy
Primary
28165
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2068689
PK
—
05
—
2857725
—
NY
Enumeration date
12/27/2006
Last updated
06/13/2025
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