Organization
WAL-MART STORES EAST LP
Active
Other names
WALMART PHARMACY 10-5315
Organization subpart
No
Provider details
NPI number
Authorized official
KIMBERLY CANONIC (SENIOR DIRECTOR, ENROLLMENT)
(479) 371-1168
Entity
Organization
Contact information
Practice address
2354 COMMERCE PARK DR STE 100, ORLANDO, FL 32819-8601
(877) 453-4566
(866) 537-0877
Mailing address
702 SW 8TH ST, BENTONVILLE, AR 72716-0445
(479) 277-1242
Taxonomy
Speciality
Code
Description
License number
State
3336S0011X
Specialty Pharmacy
021368750-03
OH
3336S0011X
Specialty Pharmacy
054.015021
IL
3336S0011X
Specialty Pharmacy
2003010214
MO
3336S0011X
Specialty Pharmacy
22601
TX
3336S0011X
Specialty Pharmacy
262265
MN
3336S0011X
Specialty Pharmacy
3872
TN
3336S0011X
Specialty Pharmacy
5301007714
MI
3336S0011X
Specialty Pharmacy
64000468A
IN
3336S0011X
Specialty Pharmacy
965
ND
3336S0011X
Specialty Pharmacy
99-6096
OK
3336S0011X
Specialty Pharmacy
FL873
KY
3336S0011X
Specialty Pharmacy
Primary
OS01543
AR
3336S0011X
Specialty Pharmacy
PH18943
FL
3336S0011X
Specialty Pharmacy
PHA-MOP-LIC-12447
MT
3336S0011X
Specialty Pharmacy
PHY.005063-OS
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
006340
—
FL
05
—
025831800
—
FL
05
—
0311413
—
NJ
05
—
100445350C
—
FL
05
—
100505069
—
FL
05
—
1007455310380
—
PA
05
—
1013934413
—
AL
05
—
1013934413
—
FL
01
—
2015188
PK
—
05
—
25831800
—
FL
05
—
3810010863
—
FL
05
—
80658873
—
CO
Enumeration date
07/16/2006
Last updated
06/12/2025
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