Organization
WAL-MART STORES EAST LP
Active
Other names
Walmart Pharmacy 10-1622
Organization subpart
No
Provider details
NPI number
Authorized official
KIMBERLY CANONIC (SENIOR DIRECTOR, ENROLLMENT)
(480) 853-0515
Entity
Organization
Contact information
Practice address
2801 W STATE ROUTE 18, TIFFIN, OH 44883-8950
(419) 447-9177
Mailing address
702 SW 8TH ST, BENTONVILLE, AR 72716-0445
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
020661400
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0822346
—
OH
01
—
2072110
PK
—
05
—
822346
—
OH
Enumeration date
07/18/2006
Last updated
07/11/2025
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