Organization
WAL-MART STORES EAST LP
Active
Other names
Wal-Mart Pharmacy 10-4501
Organization subpart
No
Provider details
NPI number
Authorized official
KIMBERLY CANONIC (SENIOR DIRECTOR, ENROLLMENT)
(480) 277-6348
Entity
Organization
Contact information
Practice address
134 DANIEL KENDALL DR, BROWNSVILLE, PA 15417-8303
(724) 364-4106
Mailing address
702 SW 8TH ST, BENTONVILLE, AR 72716-0445
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
PP482345
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100745531 0292
—
PA
01
—
2138208
PK
—
Enumeration date
11/20/2012
Last updated
08/06/2025
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