# WAL-MART STORES EAST LP

> Is this information incorrect? This page shows public data from NPPES. Update your record in NPPES and this page will update automatically within 7 days. [Update your NPPES record](https://nppes.cms.hhs.gov)

- **Entity:** Organization
- **Status:** Active
- **Other names:** WAL-MART PHARMACY 10-2421
- **Organization subpart:** No

## Provider details

- **NPI number:** 1457378523
- **Authorized official:** KIMBERLY CANONIC (SENIOR DIRECTOR, ENROLLMENT)
- **Authorized official phone:** (480) 277-6348

## Contact information

- **Practice address:** 2212 GLACIER DR, SAINT CROIX FALLS, WI 54024-8347
- **Practice address phone:** (715) 483-1499
- **Mailing address:** 702 SW 8TH ST, BENTONVILLE, AR 72716-0445

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 332B00000X | Durable Medical Equipment & Medical Supplies | — | NULL | — |
| 333600000X | Pharmacy | — | NULL | — |
| 3336C0003X | Community/Retail Pharmacy | 8476-42 | WI | Yes |

## Other

- **Enumeration date:** 07/16/2006
- **Last updated:** 05/30/2025

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 2115426 | PK | — |
| 05 | — | 224219200 | — | WI |
| 05 | — | 33205900 | — | WI |