Organization
WAL-MART STORES EAST LP
Active
Other names
WalMart Pharmacy 10-5777
Organization subpart
No
Provider details
NPI number
Authorized official
KIMBERLY CANONIC (SENIOR DIRECTOR, ENROLLMENT)
(480) 853-0515
Entity
Organization
Contact information
Practice address
450 PROVIDENCE RD, BROOKLYN, CT 06234-1823
(860) 412-5144
(860) 412-5138
Mailing address
702 SW 8TH ST, BENTONVILLE, AR 72716-0445
(479) 277-2500
(479) 277-4331
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
PCY0002274
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
008047735
—
CT
01
—
2142234
PK
—
Enumeration date
09/03/2013
Last updated
06/16/2025
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