Organization
WAL-MART STORES EAST LP
Active
Other names
Walmart Pharmacy 10-2790
Organization subpart
No
Provider details
NPI number
Authorized official
KIMBERLY CANONIC (SENIOR DIRECTOR, ENROLLMENT)
(480) 853-0515
Entity
Organization
Contact information
Practice address
10420 WALMART DR, HAGERSTOWN, MD 21740-5790
(301) 739-7597
(301) 739-7630
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
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
333600000X
Pharmacy
Primary
P07516
MD
3336C0003X
Community/Retail Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2169774
PK
—
05
—
240021900 DME
—
MD
05
—
765410300
—
MD
Enumeration date
02/22/2017
Last updated
06/12/2025
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