Organization
WAL-MART STORES EAST LP
Active
Other names
Walmart Pharmacy 10-5214
Organization subpart
No
Provider details
NPI number
Authorized official
KIMBERLY CANONIC (SENIOR DIRECTOR, ENROLLMENT)
(480) 277-6348
Entity
Organization
Contact information
Practice address
2855 N OLD LAKE WILSON ROAD, KISSIMMEE, FL 34747
(407) 606-0111
(407) 606-0112
Mailing address
702 SW 8TH ST, BENTONVILLE, AR 72716-0445
(479) 277-9170
(479) 277-4331
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
3336C0003X
Community/Retail Pharmacy
Primary
—
—
Other
Enumeration date
08/16/2017
Last updated
06/10/2025
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