Organization
WAL-MART STORES EAST LP
Active
Other names
Walmart Pharmacy 10-5421
Organization subpart
No
Provider details
NPI number
Authorized official
KIMBERLY CANONIC (SENIOR DIRECTOR, ENROLLMENT)
(480) 277-6348
Entity
Organization
Contact information
Practice address
45 SUTTERS MILL RD, SAINT PETERS, MO 63376-2759
(636) 851-6812
(636) 851-6810
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
2016000939
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1427427459
—
MO
01
—
2154945
PK
—
Enumeration date
09/21/2015
Last updated
06/10/2025
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