Organization
WAL-MART STORES EAST LP
Active
Other names
WALMART PHARMACY 10-5417
Organization subpart
No
Provider details
NPI number
Authorized official
KIMBERLY CANONIC (SENIOR DIRECTOR, ENROLLMENT)
(480) 853-0515
Entity
Organization
Contact information
Practice address
175 OUTER LOOP, LOUISVILLE, KY 40214-5544
(502) 361-8299
Mailing address
702 SW 8TH ST, BENTONVILLE, AR 72716-0445
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
P07047
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200990850A
—
IN
01
—
2034322
PK
—
05
—
5401052500
—
KY
Enumeration date
07/16/2006
Last updated
06/13/2025
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