Organization
WAL-MART STORES EAST LP
Active
Other names
Walmart Pharmacy 10-4561
Organization subpart
No
Provider details
NPI number
Authorized official
KIMBERLY CANONIC (SENIOR DIRECTOR, ENROLLMENT)
(480) 277-6348
Entity
Organization
Contact information
Practice address
9550 BAYMEADOWS RD, JACKSONVILLE, FL 32256-0710
(904) 513-5696
(904) 831-5227
Mailing address
702 SW 8TH ST, BENTONVILLE, AR 72716-0445
(479) 277-9170
(479) 277-4331
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
333600000X
Pharmacy
Primary
—
—
3336C0003X
Community/Retail Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2176849
PK
—
Enumeration date
02/23/2018
Last updated
06/10/2025
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