Organization
WAL-MART STORES EAST LP
Active
Other names
WALMART PHARMACY 10-0560
Organization subpart
No
Provider details
NPI number
Authorized official
KIMBERLY CANONIC (SENIOR DIRECTOR, ENROLLMENT)
(480) 277-6348
Entity
Organization
Contact information
Practice address
4201 N BELT HWY, SAINT JOSEPH, MO 64506-1299
(816) 233-7770
Mailing address
702 SW 8TH ST, BENTONVILLE, AR 72716-0445
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
2002008567
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2050338
PK
—
05
—
601371699
—
MO
Enumeration date
07/16/2006
Last updated
06/02/2025
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