Organization
WAL-MART STORES EAST LP
Active
Other names
Walmart Pharmacy 10-3497
Organization subpart
No
Provider details
NPI number
Authorized official
KIMBERLY CANONIC (SENIOR DIRECTOR, ENROLLMENT)
(480) 853-0515
Entity
Organization
Contact information
Practice address
428 WALTON DR, PLYMOUTH, WI 53073-5019
(920) 892-2656
(920) 892-2737
Mailing address
702 SW 8TH ST, BENTONVILLE, AR 72716-0445
(479) 204-8550
(479) 277-4331
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
8220-42
WI
3336S0011X
Specialty Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2109994
PK
—
05
—
33262300
—
WI
Enumeration date
07/16/2006
Last updated
06/19/2025
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