Organization
WAL-MART STORES EAST LP
Active
Other names
Wal-Mart Pharmacy 10-1698
Organization subpart
No
Provider details
NPI number
Authorized official
KIMBERLY CANONIC (SENIOR DIRECTOR, ENROLLMENT)
(480) 853-0515
Entity
Organization
Contact information
Practice address
3 COMMERCE DR, HOOKSETT, NH 03106-2528
(603) 621-0631
Mailing address
702 SW 8TH ST, BENTONVILLE, AR 72716-0445
(479) 277-1238
(479) 277-4331
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
3336C0003X
Community/Retail Pharmacy
Primary
0758 P
NH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2120740
PK
—
05
—
30707743
—
NH
Enumeration date
06/18/2009
Last updated
06/19/2025
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