Organization
WAL-MART STORES EAST LP
Active
Other names
Walmart Pharmacy 10-5816
Organization subpart
No
Provider details
NPI number
Authorized official
KIMBERLY CANONIC (SENIOR DIRECTOR, ENROLLMENT)
(480) 277-6348
Entity
Organization
Contact information
Practice address
1650 SAN PABLO RD S, JACKSONVILLE, FL 32224-1036
(904) 680-3232
(904) 380-3233
Mailing address
702 SW 8TH ST, MAILSTOP 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
PH29484
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
015983900
—
FL
05
—
015983901 DME
—
FL
01
—
2152241
PK
—
Enumeration date
05/26/2015
Last updated
06/10/2025
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