Organization
WAL-MART STORES EAST, LP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KIMBERLY CANONIC (DIRECTOR OF HEALTH CARE CONTRACTING)
(480) 277-6348
Entity
Organization
Contact information
Practice address
10000 OMNI DR, JACKSONVILLE, FL 32222-4171
(904) 934-6904
Mailing address
1 CUSTOMER DR, BENTONVILLE, AR 72716-0445
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
Primary
—
—
3336C0003X
Community/Retail Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
129973100
—
FL
Enumeration date
10/28/2025
Last updated
04/07/2026
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