Organization
WAL-MART STORES EAST, LP
Active
Organization
WAL-MART STORES EAST, LP
Active
Other names
WALMART PHARMACY 10-4201
Organization subpart
No
Provider details
NPI number
Authorized official
KIMBERLY CANONIC (SENIOR DIRECTOR ENROLLMENT)
(480) 853-0515
Entity
Organization
Contact information
Practice address
66 STATE ROAD 344, EDGEWOOD, NM 87015-6849
(505) 286-3053
Mailing address
702 SW 8TH ST, BENTONVILLE, AR 72716-0445
(479) 204-8550
(479) 277-4331
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
3336C0003X
Community/Retail Pharmacy
Primary
PH00003003
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2059070
PK
—
05
—
23007826
—
NM
Enumeration date
12/05/2007
Last updated
07/08/2025
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