Organization
WAL-MART STORES EAST, LP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KIMBERLY CANONIC (DIRECTOR OF HEALTH CARE CONTRACTING)
(480) 277-6348
Entity
Organization
Contact information
Practice address
3525 SE MARICAMP RD, OCALA, FL 34471-6247
(352) 390-1115
Mailing address
1 CUSTOMER DR, BENTONVILLE, AR 72716-0445
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
Primary
—
—
3336C0003X
Community/Retail Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
129973000
—
FL
05
—
130006500
—
FL
Enumeration date
10/15/2025
Last updated
02/23/2026
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