# WAL-MART STORES EAST LP.

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Walmart Pharmacy 10-3857
- **Organization subpart:** No

## Provider details

- **NPI number:** 1396945242
- **Authorized official:** KIMBERLY CANONIC (SENIOR DIRECTOR ENROLLMENT)
- **Authorized official phone:** (480) 853-0515

## Contact information

- **Practice address:** 2151 ROYAL AVE, MONONA, WI 53713-4812
- **Practice address phone:** (608) 226-8671
- **Practice address fax:** (608) 226-8674
- **Mailing address:** 702 SW 8TH ST, BENTONVILLE, AR 72716-0445
- **Mailing address phone:** (479) 204-8550
- **Mailing address fax:** (479) 277-4331

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 332B00000X | Durable Medical Equipment & Medical Supplies | — | NULL | — |
| 3336C0003X | Community/Retail Pharmacy | 8768-42 | WI | Yes |

## Other

- **Enumeration date:** 07/19/2007
- **Last updated:** 08/12/2026

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 2111056 | PK | — |
| 05 | — | 36221100 | — | WI |