Organization
WAL-MART STORES EAST , LP
Active
Other names
WAL-MART PHARMACY 10-2419
Organization subpart
No
Provider details
NPI number
Authorized official
KIMBERLY CANONIC (SENIOR DIRECTOR, ENROLLMENT)
(480) 277-6348
Entity
Organization
Contact information
Practice address
18922 REHOBOTH MALL BLVD, REHOBOTH BEACH, DE 19971-6132
(302) 644-8022
Mailing address
702 SW 8TH ST, BENTONVILLE, AR 72716-0445
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
A30000695
DE
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0001189307
—
DE
05
—
1189307
—
DE
01
—
2003943
PK
—
Enumeration date
07/17/2006
Last updated
05/30/2025
About Stedi
Stedi is the only programmable healthcare clearinghouse. You can use Stedi's APIs to process eligibility checks, claims, remits, and more.
Contact us