Organization
WAL-MART STORES EAST , LP
Active
Other names
Walmart Pharmacy 10-5336
Organization subpart
No
Provider details
NPI number
Authorized official
KIMBERLY CANONIC (SENIOR DIRECTOR, ENROLLMENT)
(480) 853-0515
Entity
Organization
Contact information
Practice address
11020 S ELM ST, JENKS, OK 74037-3002
(918) 209-7016
(918) 209-7015
Mailing address
702 SW 8TH ST, BENTONVILLE, AR 72716-6209
(479) 204-8550
(479) 277-4331
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
3336C0003X
Community/Retail Pharmacy
Primary
2-7447
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100231610Z
—
OK
01
—
2154943
PK
—
Enumeration date
08/11/2015
Last updated
06/11/2025
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