Organization
WAL-MART STORES EAST LP
Active
Other names
WAL-MART PHARMACY 10-3792
Organization subpart
No
Provider details
NPI number
Authorized official
KIMBERLY CANONIC (SENIOR DIRECTOR, ENROLLMENT)
(480) 276-6348
Entity
Organization
Contact information
Practice address
2687 N MEMORIAL DR, LANCASTER, OH 43130-1670
(740) 687-0449
Mailing address
702 SW 8TH ST, BENTONVILLE, AR 72716-0445
(479) 277-1242
(479) 277-4331
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
3336C0003X
Community/Retail Pharmacy
Primary
021789700
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2081104
PK
—
05
—
2809358
—
OH
Enumeration date
01/15/2008
Last updated
07/08/2025
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