Organization
WAL-MART STORES EAST LP
Active
Other names
Walmart Pharmacy 10-3857
Organization subpart
No
Provider details
NPI number
Authorized official
KIMBERLY CANONIC (SENIOR DIRECTOR ENROLLMENT)
(480) 853-0515
Entity
Organization
Contact information
Practice address
2151 ROYAL AVE, MONONA, WI 53713-4812
(608) 226-8671
(608) 226-8674
Mailing address
702 SW 8TH ST, BENTONVILLE, AR 72716-0445
(479) 204-8550
(479) 277-4331
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
3336C0003X
Community/Retail Pharmacy
Primary
8768-42
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2111056
PK
—
05
—
36221100
—
WI
Enumeration date
07/19/2007
Last updated
07/08/2025
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