Organization
WAL-MART STORES EAST LP
Active
Other names
Walmart Pharmacy 10-4676
Organization subpart
No
Provider details
NPI number
Authorized official
KIMBERLY CANONIC (SENIOR DIRECTOR, ENROLLMENT)
(480) 277-6348
Entity
Organization
Contact information
Practice address
1820 UNSER BLVD NW, ALBUQUERQUE, NM 87120-3933
(505) 600-4292
(505) 600-4291
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
PH00004109
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2153747
PK
—
05
—
82653887
—
NM
Enumeration date
06/30/2015
Last updated
06/10/2025
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