Organization
WAL-MART STORES EAST LP
Active
Other names
WALMART PHARMACY 10-4211
Organization subpart
No
Provider details
NPI number
Authorized official
KIMBERLY CANONIC (SENIOR DIRECTOR ENROLLMENT)
(480) 853-0515
Entity
Organization
Contact information
Practice address
5559 CLARCONA OCOEE RD, ORLANDO, FL 32810-4057
(407) 294-7176
(479) 277-4331
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
PH22117
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
031657100
—
FL
05
—
031657101
—
FL
01
—
2006804
PK
—
Enumeration date
07/17/2006
Last updated
07/09/2025
About Stedi
Stedi is the only programmable healthcare clearinghouse. You can use Stedi's APIs to process eligibility checks, claims, remits, and more.
Contact us