Organization
WAL-MART STORES EAST LP
Active
Other names
WALMART PHARMACY 10-3308
Organization subpart
No
Provider details
NPI number
Authorized official
KIMBERLY CANONIC (SENIOR DIRECTOR, ENROLLMENT)
(480) 853-0515
Entity
Organization
Contact information
Practice address
1580 BRANAN FIELD RD, MIDDLEBURG, FL 32068-8427
(904) 214-9115
(479) 277-4331
Mailing address
702 SW 8TH ST, BENTONVILLE, AR 72716-0445
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
3336C0003X
Community/Retail Pharmacy
Primary
PH22330
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
031802700
—
FL
05
—
031802701
—
FL
01
—
2007652
PK
—
Enumeration date
10/13/2006
Last updated
06/19/2025
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