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Organization
WAL-MART STORES EAST , LP
Active
Organization
WAL-MART STORES EAST , LP
Active
Other names
WAL-MART PHARMACY 10-3607
Organization subpart
No
Provider details
NPI number
Authorized official
KIMBERLY CANONIC (SENIOR DIRECTOR, ENROLLMENT)
(480) 277-6348
Entity
Organization
Contact information
Practice address
13858 ROUTE 31, ALBION, NY 14411-9362
(585) 589-0761
Mailing address
702 SW 8TH ST, BENTONVILLE, AR 72716-0445
(479) 277-1242
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
3336C0003X
Community/Retail Pharmacy
Primary
27841
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02813472
—
NY
01
—
2068092
PK
—
05
—
2813472
—
NY
Enumeration date
06/13/2006
Last updated
07/02/2025
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