Organization
WAL-MART STORES EAST LP
Active
Other names
Walmart Pharmacy 10-2396
Organization subpart
No
Provider details
NPI number
Authorized official
KIMBERLY CANONIC (SENIOR DIRECTOR, ENROLLMENT)
(480) 277-6348
Entity
Organization
Contact information
Practice address
12700 S MILITARY TRL, BOYNTON BEACH, FL 33436-6139
(561) 808-1095
(561) 808-1092
Mailing address
702 SW 8TH ST, BENTONVILLE, AR 72716-0445
(479) 277-2500
(479) 277-4331
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
3336C0003X
Community/Retail Pharmacy
Primary
PH29100
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2149148
PK
—
Enumeration date
08/21/2014
Last updated
06/06/2025
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