Organization
WAL-MART STORES EAST LP
Active
Other names
WAL-MART PHARMACY 10-3301
Organization subpart
No
Provider details
NPI number
Authorized official
KIMBERLY CANONIC (SENIOR DIRECTOR, ENROLLMENT)
(480) 853-0515
Entity
Organization
Contact information
Practice address
51 SILVER SPRING ST, PROVIDENCE, RI 02904-2557
(401) 272-5340
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
PHA00375
RI
3336S0011X
Specialty Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2089571
PK
—
05
—
WM64210
—
RI
Enumeration date
12/26/2006
Last updated
06/19/2025
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