Organization
WAL-MART STORES EAST LP
Active
Other names
WALMART PHARMACY 10-5345
Organization subpart
No
Provider details
NPI number
Authorized official
KIMBERLY CANONIC (SENIOR DIRECTOR, ENROLLMENT)
(480) 853-0515
Entity
Organization
Contact information
Practice address
10600 TOWN CENTER BLVD, DUNKIRK, MD 20754-2737
(410) 257-2913
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
P04585
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2038272
PK
—
05
—
4132572 00
—
MD
05
—
413257200
—
MD
Enumeration date
06/26/2007
Last updated
06/13/2025
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