Organization
WAL-MART STORES EAST , LP
Active
Other names
Wal-Mart Pharmacy 10-3111
Organization subpart
No
Provider details
NPI number
Authorized official
KIMBERLY CANONIC (SENIOR DIRECTOR, ENROLLMENT)
(480) 277-6348
Entity
Organization
Contact information
Practice address
545 EL CAMINO ALTO DR, SPRINGFIELD, MO 65802-4719
(417) 414-6626
(417) 414-6622
Mailing address
1 CUSTOMER DR, MS 0445, BENTONVILLE, AR 72716-0445
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
3336C0003X
Community/Retail Pharmacy
Primary
2012032335
MO
Other
Enumeration date
08/28/2012
Last updated
07/14/2026
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