Organization
WAL-MART STORES EAST LP
Active
Other names
WAL-MART PHARMACY 10-2180
Organization subpart
No
Provider details
NPI number
Authorized official
KIMBERLY CANONIC (SENIOR DIRECTOR, ENROLLMENT)
(480) 277-6348
Entity
Organization
Contact information
Practice address
55 BROOKSBY VILLAGE WAY, DANVERS, MA 01923-1444
(978) 777-6983
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
CS2874
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0447617
—
MA
05
—
187431
—
MA
01
—
2038644
PK
—
05
—
447617
—
MA
Enumeration date
07/17/2006
Last updated
06/02/2025
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