Organization
WAL-MART STORES EAST LP
Active
Other names
WalMart Pharmacy 10-5491
Organization subpart
No
Provider details
NPI number
Authorized official
KIMBERLY CANONIC (SENIOR DIRECTOR, ENROLLMENT)
(480) 853-0515
Entity
Organization
Contact information
Practice address
2266 WYOMING BLVD NE, ALBUQUERQUE, NM 87112-2620
(505) 323-2885
Mailing address
702 SW 8TH ST, BENTONVILLE, AR 72716-0445
(479) 277-1238
(479) 277-4331
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
3336C0003X
Community/Retail Pharmacy
Primary
PH00003101
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2120420
PK
—
05
—
30650861
—
NM
Enumeration date
05/13/2009
Last updated
06/16/2025
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