Organization
WAL-MART STORES EAST LP
Active
Other names
WalMart Pharmacy 10-4439
Organization subpart
No
Provider details
NPI number
Authorized official
KIMBERLY CANONIC (SENIOR DIRECTOR, ENROLLMENT)
(480) 277-6348
Entity
Organization
Contact information
Practice address
1013 S KALAMAZOO ST, PAW PAW, MI 49079-8258
(269) 415-6004
(269) 415-6005
Mailing address
702 SW 8TH ST, BENTONVILLE, AR 72716-0445
(479) 277-1242
(479) 277-4331
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
3336C0003X
Community/Retail Pharmacy
Primary
5301010462
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2144955
PK
—
Enumeration date
03/27/2014
Last updated
07/11/2025
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