Organization
WAL-MART STORES EAST LP
Active
Other names
WALMART PHARMACY 10-5250
Organization subpart
No
Provider details
NPI number
Authorized official
KIMBERLY CANONIC (SENIOR DIRECTOR, ENROLLMENT)
(480) 853-0515
Entity
Organization
Contact information
Practice address
904 CYPRESS PKWY, POINCIANA, FL 34759-3456
(407) 870-2501
(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
—
—
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
PH20782
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
026938700
—
FL
01
—
2008746
PK
—
05
—
26938700
—
FL
Enumeration date
07/16/2006
Last updated
07/02/2025
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