Organization
WAL-MART STORES EAST LP
Active
Other names
WALMART PHARMACY 10-5159
Organization subpart
No
Provider details
NPI number
Authorized official
KIMBERLY CANONIC (SENIOR DIRECTOR, ENROLLMENT)
(480) 853-0515
Entity
Organization
Contact information
Practice address
2750 COOK RD, WEST BRANCH, MI 48661-8744
(989) 343-9761
Mailing address
702 SW 8TH ST, BENTONVILLE, AR 72716-0445
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
5301007814
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2046664
PK
—
05
—
2365561
—
MI
Enumeration date
07/16/2006
Last updated
06/12/2025
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