Organization
WAL-MART STORES EAST, LP
Active
Other names
Walmart Pharmacy 10-2467
Organization subpart
No
Provider details
NPI number
Authorized official
KIMBERLY CANONIC (DIRECTOR OF HEALTH CARE CONTRACTING)
(480) 277-6348
Entity
Organization
Contact information
Practice address
4239 BERRYHILL ROAD, PACE, FL 32571-8339
(850) 463-9461
(850) 463-9464
Mailing address
1 CUSTOMER DRIVE, MS 0445, BENTONVILLE, AR 72716-0445
(479) 277-4331
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
3336C0003X
Community/Retail Pharmacy
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
128278400
—
FL
05
—
128278700
—
FL
Enumeration date
06/24/2025
Last updated
12/09/2025
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