Organization
WAL-MART STORES EAST LP
Active
Other names
WAL-MART PHARMACY 10-1790
Organization subpart
No
Provider details
NPI number
Authorized official
KIMBERLY CANONIC (SENIOR DIRECTOR, ENROLLMENT)
(480) 853-0515
Entity
Organization
Contact information
Practice address
2150 N TELEGRAPH RD, MONROE, MI 48162-8901
(734) 242-2385
Mailing address
702 SW 8TH ST, BENTONVILLE, AR 72716-0445
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
5301005770
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2041645
PK
—
05
—
2350243
—
MI
Enumeration date
07/16/2006
Last updated
06/17/2025
About Stedi
Stedi is the only programmable healthcare clearinghouse. You can use Stedi's APIs to process eligibility checks, claims, remits, and more.
Contact us