Organization
WAL-MART STORES EAST, LP
Active
Other names
Walmart Pharmacy 10-5005
Organization subpart
No
Provider details
NPI number
Authorized official
KIMBERLY CANONIC (SENIOR DIRECTOR, ENROLLMENT)
(480) 277-6348
Entity
Organization
Contact information
Practice address
6855 WILSON BLVD, JACKSONVILLE, FL 32210-3600
(904) 513-6627
(904) 513-6628
Mailing address
702 SW 8TH ST, MAILSTOP 0445, BENTONVILLE, AR 72716-0445
(479) 277-1242
(479) 277-4331
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
PH28632
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
013628900
—
FL
01
—
2147309
PK
—
Enumeration date
07/22/2014
Last updated
06/10/2025
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