Organization
WAL-MART STORES EAST LP
Active
Other names
WalMart Pharmacy 104368
Organization subpart
No
Provider details
NPI number
Authorized official
KIMBERLY CANONIC (SENIOR DIRECTOR, ENROLLMENT)
(480) 853-0515
Entity
Organization
Contact information
Practice address
34 BAHIA AVE, OCALA, FL 34472-2213
(352) 537-3102
Mailing address
702 SW 8TH ST, BENTONVILLE, AR 72716-0445
(479) 204-6375
(479) 277-4331
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
3336C0003X
Community/Retail Pharmacy
Primary
PH26890
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
009083300
—
FL
01
—
2140571
PK
—
Enumeration date
05/30/2013
Last updated
07/09/2025
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