Organization
WAL-MART STORES EAST LP
Active
Other names
WALMART PHARMACY 10-4380
Organization subpart
No
Provider details
NPI number
Authorized official
KIMBERLY CANONIC (SENIOR DIRECTOR, ENROLLMENT)
(480) 853-0515
Entity
Organization
Contact information
Practice address
10635 W ATLANTIC BLVD, CORAL SPRINGS, FL 33071-5669
(954) 345-9250
(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
—
—
3336C0003X
Community/Retail Pharmacy
Primary
PH22770
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
032152400
—
FL
05
—
032152401
—
FL
01
—
2009117
PK
—
Enumeration date
05/21/2007
Last updated
07/10/2025
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