Organization
WAL-MART STORES EAST LP
Active
Other names
WAL-MART PHARMACY 10-3293
Organization subpart
No
Provider details
NPI number
Authorized official
KIMBERLY CANONIC (SENIOR DIRECTOR, ENROLLMENT)
(480) 853-0515
Entity
Organization
Contact information
Practice address
223 MEADOWLANDS DR, CHARDON, OH 44024-8366
(440) 286-1056
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
021596350
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2080397
PK
—
05
—
2672862
—
OH
05
—
26728632
—
OH
Enumeration date
06/03/2006
Last updated
06/18/2025
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