Organization
WAL-MART STORES EAST LP
Active
Other names
WAL-MART PHARMACY 10-1741
Organization subpart
No
Provider details
NPI number
Authorized official
KIMBERLY CANONIC (SENIOR DIRECTOR, ENROLLMENT)
(480) 853-0515
Entity
Organization
Contact information
Practice address
939 N DUPONT BLVD, MILFORD, DE 19963-1072
(302) 422-0429
Mailing address
702 SW 8TH ST, BENTONVILLE, AR 72716-0445
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
A30000632
DE
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0000378207
—
DE
01
—
2003711
PK
—
05
—
378207
—
DE
Enumeration date
07/17/2006
Last updated
06/18/2025
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