Organization
WAL-MART STORES EAST LP
Active
Other names
WalMart Pharmacy 10-5472
Organization subpart
No
Provider details
NPI number
Authorized official
KIMBERLY CANONIC (SENIOR DIRECTOR, ENROLLMENT)
(480) 853-0515
Entity
Organization
Contact information
Practice address
7000 E MICHIGAN AVE, SALINE, MI 48176-9514
(734) 944-2098
Mailing address
702 SW 8TH ST, BENTONVILLE, AR 72716-0445
(479) 277-1238
(479) 277-4331
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
3336C0003X
Community/Retail Pharmacy
Primary
5301009069
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1336376250
—
MI
01
—
2120759
PK
—
Enumeration date
06/18/2009
Last updated
06/13/2025
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