Organization
WAL-MART STORES EAST LP
Active
Other names
WALMART PHARMACY 10-3309
Organization subpart
No
Provider details
NPI number
Authorized official
KIMBERLY CANONIC (SENIOR DIRECTOR, ENROLLMENT)
(480) 853-0515
Entity
Organization
Contact information
Practice address
4250 PHILIPS HWY, JACKSONVILLE, FL 32207-6730
(904) 737-7001
(479) 277-4331
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
PH22042
FL
3336S0011X
Specialty Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
031565600
—
FL
01
—
2006721
PK
—
Enumeration date
06/12/2006
Last updated
06/19/2025
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