Organization
WAL-MART STORES EAST LP
Active
Other names
Walmart Pharmacy 10-5782
Organization subpart
No
Provider details
NPI number
Authorized official
KIMBERLY CANONIC (SENIOR DIRECTOR, ENROLLMENT)
(480) 853-0515
Entity
Organization
Contact information
Practice address
150 SONOMA RANCH BLVD, LAS CRUCES, NM 88011-1608
(575) 323-6097
(575) 323-6096
Mailing address
702 SW 8TH ST, MAIL STOP 0445, 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
Primary
PH00004279
NM
3336C0003X
Community/Retail Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2160581
PK
—
Enumeration date
05/27/2016
Last updated
06/11/2025
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