Organization
WAL-MART STORES EAST LP
Active
Other names
Wal-Mart Pharmacy 10-4276
Organization subpart
No
Provider details
NPI number
Authorized official
KIMBERLY CANONIC (SENIOR DIRECTOR, ENROLLMENT)
(480) 277-6348
Entity
Organization
Contact information
Practice address
1325 MAIN ST, TAYLOR, PA 18504-3213
(570) 344-5220
Mailing address
702 SW 8TH ST, MAIL STOP 0445, BENTONVILLE, AR 72716-6209
(479) 277-1242
(479) 277-4331
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
3336C0003X
Community/Retail Pharmacy
Primary
PP482029
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1007455310286
—
PA
01
—
2125147
PK
—
Enumeration date
05/13/2010
Last updated
07/09/2025
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