Organization
WAL-MART STORES EAST LP
Active
Other names
WALMART PHARMACY 10-4498
Organization subpart
No
Provider details
NPI number
Authorized official
KIMBERLY CANONIC (SENIOR DIRECTOR, ENROLLMENT)
(480) 277-6348
Entity
Organization
Contact information
Practice address
4650 N UNIVERSITY DR, CORAL SPRINGS, FL 33067-4626
(954) 753-7181
(479) 277-4331
Mailing address
702 SW 8TH ST, BENTONVILLE, AR 72716-0445
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
3336C0003X
Community/Retail Pharmacy
Primary
PH22977
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
032253900
—
FL
05
—
032253901
—
FL
01
—
2009774
PK
—
05
—
32253900
—
FL
Enumeration date
07/27/2007
Last updated
08/06/2025
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