Organization
WAL-MART STORES EAST LP
Active
Other names
WALMART PHARMACY 10-4241
Organization subpart
No
Provider details
NPI number
Authorized official
KIMBERLY CANONIC (SENIOR DIRECTOR, ENROLLMENT)
(480) 853-0515
Entity
Organization
Contact information
Practice address
4545 W 6TH AVE, STILLWATER, OK 74074-1523
(405) 707-0756
Mailing address
702 SW 8TH ST, BENTONVILLE, AR 72716-0445
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
3336C0003X
Community/Retail Pharmacy
Primary
8-5133
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100240050H
—
OK
05
—
100240050L
—
OK
01
—
2077115
PK
—
Enumeration date
12/27/2006
Last updated
08/12/2025
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