Organization
WAL-MART STORES EAST LP
Active
Other names
WalMart Pharmacy 10-3860
Organization subpart
No
Provider details
NPI number
Authorized official
KIMBERLY CANONIC (SENIOR DIRECTOR ENROLLMENT)
(480) 853-0515
Entity
Organization
Contact information
Practice address
200 GOLDIE RD, YOUNGSTOWN, OH 44505-1948
(330) 759-2689
Mailing address
702 SW 8TH ST, BENTONVILLE, AR 72716-0445
(479) 277-1238
(479) 277-4331
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
3336C0003X
Community/Retail Pharmacy
Primary
021974300
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2120749
PK
—
05
—
2995737
—
OH
Enumeration date
06/18/2009
Last updated
07/08/2025
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