Organization
WAL-MART STORES EAST LP
Active
Other names
WALMART PHARMACY 10-0379
Organization subpart
No
Provider details
NPI number
Authorized official
KIMBERLY CANONIC (SENIOR DIRECTOR, ENROLLMENT)
(480) 277-6348
Entity
Organization
Contact information
Practice address
2004 W MARLER LN, OZARK, MO 65721-7661
(417) 581-3288
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
2002009755
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2050217
PK
—
05
—
601294358
—
MO
Enumeration date
07/16/2006
Last updated
05/30/2025
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