Organization
WAL-MART STORES EAST LP
Active
Other names
WALMART PHARMACY 10-1893
Organization subpart
No
Provider details
NPI number
Authorized official
KIMBERLY CANONIC (SENIOR DIRECTOR, ENROLLMENT)
(480) 853-0515
Entity
Organization
Contact information
Practice address
3300 CRAIN HWY, BOWIE, MD 20716-1398
(301) 805-8853
(301) 805-8855
Mailing address
702 SW 8TH ST, BENTONVILLE, AR 72716-0445
(479) 277-9170
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
3336C0003X
Community/Retail Pharmacy
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2034795
PK
—
05
—
290680500
—
MD
Enumeration date
07/16/2006
Last updated
06/12/2025
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