Organization
WAL-MART STORES EAST LP
Active
Other names
WAL-MART PHARMACY 10-3803
Organization subpart
No
Provider details
NPI number
Authorized official
KIMBERLY CANONIC (SENIOR DIRECTOR, ENROLLMENT)
(480) 277-6348
Entity
Organization
Contact information
Practice address
515 SAW MILL RD, WEST HAVEN, CT 06516-4000
(203) 931-2221
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
—
—
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
PCY0002080
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
004266814
—
CT
05
—
008045266
—
CT
01
—
2002810
PK
—
Enumeration date
03/14/2007
Last updated
07/08/2025
About Stedi
Stedi is the only programmable healthcare clearinghouse. You can use Stedi's APIs to process eligibility checks, claims, remits, and more.
Contact us