Organization
WAL-MART STORES EAST, LP
Active
Other names
Walmart Pharmacy 10-2983
Organization subpart
No
Provider details
NPI number
Authorized official
KIMBERLY CANONIC (SENIOR DIRECTOR, BILLING)
(480) 277-6348
Entity
Organization
Contact information
Practice address
6275 US - 90, MILTON, FL 32570-9998
(850) 750-3083
(850) 750-3084
Mailing address
702 SW 8TH ST, BENTONVILLE, AR 72716-6209
(405) 202-9925
(479) 277-4331
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
3336C0003X
Community/Retail Pharmacy
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
127799700
—
FL
05
—
127801600DME
—
FL
Enumeration date
05/20/2025
Last updated
04/22/2026
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