Organization
WAL-MART STORES EAST LP
Active
Other names
WAL-MART PHARMACY 10-5309
Organization subpart
No
Provider details
NPI number
Authorized official
KIMBERLY CANONIC (SENIOR DIRECTOR, ENROLLMENT)
(480) 853-0515
Entity
Organization
Contact information
Practice address
46440 US HIGHWAY 20, OBERLIN, OH 44074-9475
(440) 774-6734
Mailing address
702 SW 8TH ST, BENTONVILLE, AR 72716-0445
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
3336C0003X
Community/Retail Pharmacy
Primary
021611850
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2080468
PK
—
05
—
2692206
—
OH
Enumeration date
08/10/2006
Last updated
06/13/2025
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