# WAL-MART STORES EAST LP

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- **Entity:** Organization
- **Status:** Active
- **Other names:** WalMart Pharmacy 10-4188
- **Organization subpart:** No

## Provider details

- **NPI number:** 1750623054
- **Authorized official:** KIMBERLY CANONIC (SENIOR DIRECTOR, ENROLLMENT)
- **Authorized official phone:** (480) 277-6348

## Contact information

- **Practice address:** 1410 FLORENCE BLVD, FLORENCE, AL 35630-2700
- **Practice address phone:** (256) 712-6198
- **Practice address fax:** (256) 767-4062
- **Mailing address:** 702 SW 8TH ST, BENTONVILLE, AR 72716-0445
- **Mailing address phone:** (479) 277-2500
- **Mailing address fax:** (479) 277-4331

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 3336C0003X | Community/Retail Pharmacy | 114120 | AL | Yes |

## Other

- **Enumeration date:** 03/25/2013
- **Last updated:** 06/06/2025