Organization
WAL-MART STORES EAST LP
Active
Other names
WALMART PHARMACY 10-1167
Organization subpart
No
Provider details
NPI number
Authorized official
KIMBERLY CANONIC (SENIOR DIRECTOR, ENROLLMENT)
(480) 277-6348
Entity
Organization
Contact information
Practice address
3500 BRUMBACK BLVD, KENOSHA, WI 53144-4816
(262) 652-1458
Mailing address
702 SW 8TH ST, BENTONVILLE, AR 72716-6209
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
8927-42
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2114787
PK
—
05
—
33157700
—
WI
Enumeration date
07/16/2006
Last updated
06/05/2025
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