Organization
WAL-MART STORES EAST LP
Active
Other names
Walmart Pharmacy 10-4427
Organization subpart
No
Provider details
NPI number
Authorized official
KIMBERLY CANONIC (SENIOR DIRECTOR, ENROLLMENT)
(480) 277-6348
Entity
Organization
Contact information
Practice address
3221 N MONROE ST, TALLAHASSEE, FL 32303-2821
(850) 562-2829
Mailing address
702 SW 8TH ST, BENTONVILLE, AR 72716-0445
(479) 277-1242
(479) 277-4331
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
PH23913
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2118781
PK
—
05
—
837500
—
FL
Enumeration date
01/26/2009
Last updated
07/11/2025
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