Organization
WAL-MART STORES EAST LP
Active
Other names
WAL-MART PHARMACY 10-1635
Organization subpart
No
Provider details
NPI number
Authorized official
KIMBERLY CANONIC (SENIOR DIRECTOR, ENROLLMENT)
(480) 853-0515
Entity
Organization
Contact information
Practice address
2000 S WEST AVE, WAUKESHA, WI 53189-7516
(262) 521-9204
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
9030-042
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2115172
PK
—
05
—
33180600
—
WI
Enumeration date
07/16/2006
Last updated
07/11/2025
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