Organization
WAL-MART STORES EAST LP
Active
Other names
Walmart Pharmacy 10-4281
Organization subpart
No
Provider details
NPI number
Authorized official
KIMBERLY CANONIC (SENIOR DIRECTOR, ENROLLMENT)
(480) 277-6348
Entity
Organization
Contact information
Practice address
800 W 10TH ST S, LADYSMITH, WI 54848-6301
(715) 532-2721
(715) 532-2724
Mailing address
702 SW 8TH ST, MAIL STOP 0445, BENTONVILLE, AR 72716-0445
(479) 277-1242
(479) 277-4331
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
3336C0003X
Community/Retail Pharmacy
Primary
8767-42
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2111057
PK
—
05
—
36221000
—
WI
Enumeration date
07/19/2007
Last updated
07/09/2025
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