Organization
WAL-MART STORES EAST LP
Active
Other names
WalMart Pharmacy 10-3517
Organization subpart
No
Provider details
NPI number
Authorized official
KIMBERLY CANONIC (SENIOR DIRECTOR, ENROLLMENT)
(480) 277-6348
Entity
Organization
Contact information
Practice address
1115 NM HWY 528 SE, RIO RANCHO, NM 87124
(505) 600-4053
(505) 600-4054
Mailing address
702 SW 8TH ST, BENTONVILLE, AR 72716-0445
(479) 258-2115
(479) 277-4331
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
3336C0003X
Community/Retail Pharmacy
Primary
PH00003770
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2147363
PK
—
05
—
73934062
—
NM
Enumeration date
08/06/2014
Last updated
06/05/2025
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