Organization
WAL-MART STORES EAST LP
Active
Other names
WALMART PHARMACY10-5386
Organization subpart
No
Provider details
NPI number
Authorized official
KIMBERLY CANONIC (SENIOR DIRECTOR, ENROLLMENT)
(480) 853-0515
Entity
Organization
Contact information
Practice address
14700 US 31, GRAND HAVEN, MI 49417-8390
(616) 844-4184
Mailing address
702 SW 8TH ST, BENTONVILLE, AR 72716-0445
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
3336C0003X
Community/Retail Pharmacy
Primary
5301008681
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1134328610
—
MI
01
—
2042684
PK
—
05
—
2369848
—
MI
Enumeration date
07/13/2007
Last updated
06/13/2025
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