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Organization
WAL-MART STORES EAST LP
Active
Organization
WAL-MART STORES EAST LP
Active
Other names
WAL-MART PHARMACY 10-3332
Organization subpart
No
Provider details
NPI number
Authorized official
KIMBERLY CANONIC (SENIOR DIRECTOR, ENROLLMENT)
(480) 853-0515
Entity
Organization
Contact information
Practice address
1818 STATE ROUTE 3, FULTON, NY 13069-1572
(315) 598-1773
Mailing address
702 SW 8TH ST, BENTONVILLE, AR 72716-0445
(479) 204-8550
(479) 277-4331
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
3336C0003X
Community/Retail Pharmacy
Primary
028855
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02965355
—
NY
01
—
2070138
PK
—
Enumeration date
01/16/2008
Last updated
06/19/2025
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