Organization
WAL-MART STORES EAST LP
Active
Other names
WalMart Pharmacy 10-5767
Organization subpart
No
Provider details
NPI number
Authorized official
KIMBERLY CANONIC (SENIOR DIRECTOR, ENROLLMENT)
(480) 277-6348
Entity
Organization
Contact information
Practice address
9354 AMBLESIDE DR, FISHERS, IN 46038-8327
(317) 567-8413
(317) 567-8407
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
60006366B
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
201207950A
—
IN
01
—
2142760
PK
—
Enumeration date
10/11/2013
Last updated
06/06/2025
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