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Organization
WAL-MART STORES EAST LP
Active
Organization
WAL-MART STORES EAST LP
Active
Other names
WAL-MART PHARMACY 10-3842
Organization subpart
No
Provider details
NPI number
Authorized official
KIMBERLY CANONIC (SENIOR DIRECTOR ENROLLMENT)
(480) 853-0515
Entity
Organization
Contact information
Practice address
425 ROUTE 31, MACEDON, NY 14502-9108
(315) 986-7153
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
28361
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02892006
—
NY
01
—
2069070
PK
—
Enumeration date
04/20/2007
Last updated
07/08/2025
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