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Organization
WAL-MART STORES EAST LP
Active
Organization
WAL-MART STORES EAST LP
Active
Other names
WAL-MART PHARMACY 10-3409
Organization subpart
No
Provider details
NPI number
Authorized official
KIMBERLY CANONIC (SENIOR DIRECTOR, ENROLLMENT)
(480) 853-0515
Entity
Organization
Contact information
Practice address
20 SOOJIAN DR, LEICESTER, MA 01524-1946
(508) 892-4058
Mailing address
702 SW 8TH ST, BENTONVILLE, AR 72716-0445
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
NULL
3336C0003X
Community/Retail Pharmacy
Primary
DS3506
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0408255
—
MA
01
—
2039696
PK
—
Enumeration date
03/14/2007
Last updated
06/19/2025
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