Organization
WAL-MART STORES EAST LP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KIMBERLY CANONIC (SENIOR DIRECTOR, ENROLLMENT)
(480) 853-0515
Entity
Organization
Contact information
Practice address
820 BALMY BEACH DR, APOPKA, FL 32703-0000
(407) 457-6293
(407) 457-6298
Mailing address
702 SW 8TH ST, BENTONVILLE, AR 72716-0445
(479) 277-2500
(479) 277-4331
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
333600000X
Pharmacy
Primary
PH31236
FL
3336C0003X
Community/Retail Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
024284300
—
FL
05
—
024284301 DME
—
FL
01
—
2175190
PK
—
Enumeration date
11/27/2017
Last updated
06/11/2025
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