Organization
WAL-MART STORES EAST LP
Active
Other names
Walmart Pharmacy 10-5364
Organization subpart
No
Provider details
NPI number
Authorized official
KIMBERLY CANONIC (SENIOR DIRECTOR, ENROLLMENT)
(480) 853-0515
Entity
Organization
Contact information
Practice address
2315 N PERKINS RD, STILLWATER, OK 74075-2203
(405) 564-7115
(405) 564-7114
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
Primary
87701
OK
3336C0003X
Community/Retail Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100240050P
—
OK
01
—
2164199
PK
—
Enumeration date
09/15/2016
Last updated
06/11/2025
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