Organization
WAL-MART STORES EAST, LP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KIMBERLY CANONIC (DIRECTOR OF HEALTH CARE CONTRACTING)
(480) 277-6348
Entity
Organization
Contact information
Practice address
1115 WAXMAN DR, THE VILLAGES, FL 32163-6115
(352) 461-5369
Mailing address
1 CUSTOMER DR, BENTONVILLE, AR 72716-0445
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
333600000X
Pharmacy
Primary
—
—
3336C0003X
Community/Retail Pharmacy
—
—
Other
Enumeration date
11/17/2025
Last updated
11/17/2025
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