Organization
WAL-MART STORES EAST LP
Active
Other names
Walmart Pharmacy 10-5805
Organization subpart
No
Provider details
NPI number
Authorized official
KIMBERLY CANONIC (SR. DIRECTOR)
(480) 853-0515
Entity
Organization
Contact information
Practice address
3571 W ROCK CREEK RD, NORMAN, OK 73072-2473
(405) 515-7286
(405) 515-7287
Mailing address
1 CUSTOMER DR, MS 0445, BENTONVILLE, AR 72716-0445
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
3336C0003X
Community/Retail Pharmacy
Primary
7-6284
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100231610E
—
OK
01
—
2140563
PK
—
Enumeration date
03/15/2013
Last updated
06/15/2026
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