Organization
WAL-MART STORES EAST LP
Active
Organization
WAL-MART STORES EAST LP
Active
Other names
Wal-Mart Pharmacy 10-3011
Organization subpart
No
Provider details
NPI number
Authorized official
KIMBERLY CANONIC (SENIOR DIRECTOR, ENROLLMENT)
(480) 277-6348
Entity
Organization
Contact information
Practice address
9840 S MILITARY TRL, BOYNTON BEACH, FL 33436-3201
(561) 509-2142
Mailing address
702 SW 8TH ST, BENTONVILLE, AR 72716-0445
(479) 204-0709
(479) 277-4331
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
PH 26584
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
008297600
—
FL
05
—
008297601
—
FL
01
—
2138035
PK
—
Enumeration date
11/20/2012
Last updated
06/05/2025
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