Organization
WAL-MART STORES EAST LP
Active
Other names
WALMART PHARMACY 10-2357
Organization subpart
No
Provider details
NPI number
Authorized official
KIMBERLY CANONIC (SENIOR DIRECTOR, ENROLLMENT)
(480) 277-6348
Entity
Organization
Contact information
Practice address
20910 FREDERICK RD, GERMANTOWN, MD 20876-4134
(301) 515-6703
(301) 515-6705
Mailing address
702 SW 8TH ST, BENTONVILLE, AR 72716-0445
(479) 277-9170
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
333600000X
Pharmacy
Primary
P01987
MD
3336C0003X
Community/Retail Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2035965
PK
—
05
—
416450400
—
MD
Enumeration date
07/16/2006
Last updated
06/02/2025
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