Organization
WAL-MART STORES EAST, LP
Active
Parent organization
WALMART INC
Organization subpart
Yes
Provider details
NPI number
Legal business name
WALMART INC
Authorized official
KIMBERLY CANONIC (SENIOR DIRECTOR, ENROLLMENT)
(480) 853-0515
Entity
Organization
Contact information
Practice address
3031 MID RIVERS MALL DR, SAINT PETERS, MO 63376-3426
(636) 697-1051
Mailing address
702 SW 8TH ST, MAILSTOP 0445, BENTONVILLE, AR 72716-0445
(479) 204-8550
(479) 277-4331
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
3336C0003X
Community/Retail Pharmacy
Primary
20160000940
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2154965
PK
—
05
—
600028199
—
MO
Enumeration date
10/26/2015
Last updated
06/12/2025
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