# WAL-MART STORES EAST LP

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- **Entity:** Organization
- **Status:** Active
- **Other names:** WAL-MART PHARMACY 10-1863
- **Organization subpart:** No

## Provider details

- **NPI number:** 1649297839
- **Authorized official:** KIMBERLY CANONIC (SENIOR DIRECTOR, ENROLLMENT)
- **Authorized official phone:** (480) 853-0515

## Contact information

- **Practice address:** 33752 VINE ST, WILLOWICK, OH 44095-5100
- **Practice address phone:** (440) 269-8828
- **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 | 020716500 | OH | Yes |

## Other

- **Enumeration date:** 07/16/2006
- **Last updated:** 06/12/2025