Organization
WAL-MART STORES EAST , LP
Active
Other names
WAL-MART PHARMACY 10-1980
Organization subpart
No
Provider details
NPI number
Authorized official
KIMBERLY CANONIC (SENIOR DIRECTOR, ENROLLMENT)
(480) 277-6348
Entity
Organization
Contact information
Practice address
625 SCHOOL ST, PUTNAM, CT 06260-2424
(860) 928-4199
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
PCY.0001553
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
004145472
—
CT
01
—
2001490
PK
—
05
—
940004145472
—
CT
Enumeration date
07/16/2006
Last updated
06/06/2025
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