Organization
WAL-MART STORES EAST LP
Active
Other names
WALMART PHARMACY 10-0337
Organization subpart
No
Provider details
NPI number
Authorized official
KIMBERLY CANONIC (SENIOR DIRECTOR, ENROLLMENT)
(480) 277-6348
Entity
Organization
Contact information
Practice address
1025 WALTON DR, FREDERICKTOWN, MO 63645-7235
(573) 783-2663
Mailing address
702 SW 8TH ST, BENTONVILLE, AR 72716-0445
(479) 204-8550
(479) 277-4331
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
2002009936
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2051478
PK
—
05
—
603296708
—
MO
Enumeration date
07/16/2006
Last updated
05/30/2025
About Stedi
Stedi is the only programmable healthcare clearinghouse. You can use Stedi's APIs to process eligibility checks, claims, remits, and more.
Contact us