Organization
WAL-MART STORES EAST , LP
Active
Other names
Walmart Pharmacy 10-6942
Organization subpart
No
Provider details
NPI number
Authorized official
KIMBERLY CANONIC (SENIOR DIRECTOR, ENROLLMENT)
(480) 277-6348
Entity
Organization
Contact information
Practice address
4851 W. HOUSTON ST, BROKEN ARROW, OK 74012
(918) 505-6094
(918) 505-6095
Mailing address
702 SW 8TH ST, BENTONVILLE, AR 72716-0445
(479) 277-1242
(479) 277-4331
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
3336C0003X
Community/Retail Pharmacy
Primary
2-6710
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100231610V
—
OK
01
—
2148052
PK
—
Enumeration date
09/19/2014
Last updated
06/09/2025
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