Organization
WAL-MART STORES EAST LP
Active
Other names
Wal-Mart Pharmacy 10-2774
Organization subpart
No
Provider details
NPI number
Authorized official
KIMBERLY CANONIC (SENIOR DIRECTOR, ENROLLMENT)
(480) 277-6348
Entity
Organization
Contact information
Practice address
7730 SAWMILL RD, DUBLIN, OH 43016-9297
(614) 943-6505
(614) 943-6506
Mailing address
702 SW 8TH ST, BENTONVILLE, AR 72716-0445
(479) 277-1242
(479) 277-4331
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
3336C0003X
Community/Retail Pharmacy
Primary
RPTC.022398250-03
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2144938
PK
—
Enumeration date
03/26/2014
Last updated
06/06/2025
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