Organization
WAL-MART STORES EAST LP
Active
Organization
WAL-MART STORES EAST LP
Active
Other names
WAL-MART PHARMACY 10-3429
Organization subpart
No
Provider details
NPI number
Authorized official
KIMBERLY CANONIC (SENIOR DIRECTOR, ENROLLMENT)
(480) 853-0515
Entity
Organization
Contact information
Practice address
2901 MARKET ST, WARREN, PA 16365-5216
(814) 723-8250
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
PP481689
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1007455310247
—
PA
01
—
2081768
PK
—
Enumeration date
03/15/2007
Last updated
06/19/2025
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