Organization
WAL-MART STORES EAST LP
Active
Other names
Walmart Pharmacy 10-2946
Organization subpart
No
Provider details
NPI number
Authorized official
KIMBERLY CANONIC (SENIOR DIRECTOR, ENROLLMENT)
(480) 277-6348
Entity
Organization
Contact information
Practice address
2500 W BROWARD BLVD, FORT LAUDERDALE, FL 33312-1300
(954) 453-6537
(954) 453-6536
Mailing address
702 SW 8TH ST, MAILSTOP 0445, BENTONVILLE, AR 72716-0445
(479) 204-8550
(479) 277-4331
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
PH29602
FL
3336S0011X
Specialty Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
016492300
—
FL
05
—
016492301 DME
—
FL
01
—
2155106
PK
—
Enumeration date
10/06/2015
Last updated
06/06/2025
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