Organization
WAL-MART STORES EAST LP
Active
Other names
WAL-MART PHARMACY 10-3791
Organization subpart
No
Provider details
NPI number
Authorized official
KIMBERLY CANONIC (SENIOR DIRECTOR, ENROLLMENT)
(480) 277-6348
Entity
Organization
Contact information
Practice address
101 S TOLBERT DR, THREE RIVERS, MI 49093-8276
(269) 273-7833
Mailing address
702 SW 8TH ST, BENTONVILLE, AR 72716-0445
(479) 277-1242
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
3336C0003X
Community/Retail Pharmacy
Primary
5301008680
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2042683
PK
—
05
—
2369836
—
MI
Enumeration date
06/29/2007
Last updated
07/08/2025
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