Organization
WAL-MART STORES EAST LP
Active
Other names
WALMART PHARMACY 10-3817
Organization subpart
No
Provider details
NPI number
Authorized official
KIMBERLY CANONIC (SENIOR DIRECTOR, ENROLLMENT)
(480) 277-6348
Entity
Organization
Contact information
Practice address
433 S AVALON PARK BLVD, ORLANDO, FL 32828-6996
(407) 207-1958
(479) 277-4331
Mailing address
702 SW 8TH ST, BENTONVILLE, AR 72716-0445
(479) 277-1242
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
PH21922
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
031384000
—
FL
05
—
031384001DME
—
FL
01
—
2006465
PK
—
05
—
PH21922
—
FL
Enumeration date
07/19/2006
Last updated
07/08/2025
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