Organization
WAL-MART STORES EAST LP
Active
Other names
WALMART PHARMACY 10-2460
Organization subpart
No
Provider details
NPI number
Authorized official
KIMBERLY CANONIC (SENIOR DIRECTOR, ENROLLMENT)
(480) 853-0515
Entity
Organization
Contact information
Practice address
22899 SUSSEX HWY, SEAFORD, DE 19973-5851
(302) 628-9824
Mailing address
1 CUSTOMER DR, BENTONVILLE, AR 72716-0445
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
A30000633
DE
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0000778207
—
DE
01
—
2003780
PK
—
05
—
778207
—
DE
Enumeration date
07/16/2006
Last updated
03/31/2026
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