Organization
WAL-MART STORES EAST LP
Active
Other names
Walmart Pharmacy 10-1594
Organization subpart
No
Provider details
NPI number
Authorized official
KIMBERLY CANONIC (SENIOR DIRECTOR, ENROLLMENT)
(480) 277-6348
Entity
Organization
Contact information
Practice address
911 HEBRON RD, HEATH, OH 43056-1182
(740) 522-4903
Mailing address
702 SW 8TH ST, MAIL STOP 0445, BENTONVILLE, AR 72716-0445
(479) 277-1242
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
020644450
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0816380
—
OH
01
—
2071976
PK
—
05
—
816380
—
OH
Enumeration date
07/16/2006
Last updated
07/14/2025
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