Organization
WAL-MART STORES EAST LP
Active
Other names
WALMART PHARMACY 10-5436
Organization subpart
No
Provider details
NPI number
Authorized official
KIMBERLY CANONIC (SENIOR DIRECTOR, ENROLLMENT)
(480) 853-0515
Entity
Organization
Contact information
Practice address
1251 CENTERVILLE RD, WILMINGTON, DE 19808-6240
(302) 998-2626
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
A30000762
DE
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1000039059
—
DE
01
—
2004012
PK
—
05
—
A30000462
—
DE
Enumeration date
02/12/2007
Last updated
06/13/2025
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