Organization
WAL-MART STORES EAST LP
Active
Other names
WALMART PHARMACY 100589
Organization subpart
No
Provider details
NPI number
Authorized official
KIMBERLY CANONIC (SENIOR DIRECTOR, ENROLLMENT)
(480) 277-6348
Entity
Organization
Contact information
Practice address
11901 STANDIFORD PLAZA DR, LOUISVILLE, KY 40229-5906
(502) 968-6766
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
P06459
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2033075
PK
—
05
—
5401004600
—
KY
05
—
5403465700
—
KY
Enumeration date
07/16/2006
Last updated
06/02/2025
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