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Organization
WAL-MART STORES EAST LP
Active
Organization
WAL-MART STORES EAST LP
Active
Other names
WALMART PHARMACY 10-5498
Organization subpart
No
Provider details
NPI number
Authorized official
KIMBERLY CANONIC (SENIOR DIRECTOR, ENROLLMENT)
(480) 853-0515
Entity
Organization
Contact information
Practice address
7155 STATE ROUTE 12, LOWVILLE, NY 13367-2829
(315) 376-4174
Mailing address
702 SW 8TH ST, BENTONVILLE, AR 72716-0445
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
27686
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2066385
PK
—
05
—
2743704
—
NY
05
—
27686
—
NY
Enumeration date
07/16/2006
Last updated
06/16/2025
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