Organization
WAL-MART STORES EAST LP
Active
Other names
WALMART PHARMACY 10-1021
Organization subpart
No
Provider details
NPI number
Authorized official
KIMBERLY CANONIC (SENIOR DIRECTOR, ENROLLMENT)
(480) 277-6348
Entity
Organization
Contact information
Practice address
500 WARREN COUNTY CTR, WARRENTON, MO 63383-3023
(636) 456-4243
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
2002009460
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2050803
PK
—
05
—
602368508
—
MO
Enumeration date
07/16/2006
Last updated
06/04/2025
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