Organization
WAL-MART STORES EAST LP
Active
Other names
Walmart Pharmacy 10-3643
Organization subpart
No
Provider details
NPI number
Authorized official
KIMBERLY CANONIC (SENIOR DIRECTOR, ENROLLMENT)
(480) 277-6348
Entity
Organization
Contact information
Practice address
1010 N 8TH ST, MEDFORD, WI 54451-1278
(715) 748-9000
(715) 748-9022
Mailing address
702 SW 8TH ST, BENTONVILLE, AR 72716-0445
(479) 277-1242
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
3336C0003X
Community/Retail Pharmacy
Primary
8823-42
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2111088
PK
—
05
—
36224800
—
WI
Enumeration date
01/16/2008
Last updated
07/02/2025
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