Organization
WAL-MART STORES EAST, LP
Active
Other names
Walmart Pharmacy 10-0928
Organization subpart
No
Provider details
NPI number
Authorized official
KIMBERLY CANONIC (SENIOR DIRECTOR, ENROLLMENT)
(480) 277-6348
Entity
Organization
Contact information
Practice address
845 DURBIN PAVILION DR, SAINT JOHNS, FL 32259-0000
(479) 277-9170
Mailing address
702 SW 8TH ST, BENTONVILLE, AR 72716-0445
(479) 277-9170
(479) 277-4331
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
3336C0003X
Community/Retail Pharmacy
Primary
—
—
3336S0011X
Specialty Pharmacy
—
—
Other
Enumeration date
08/16/2018
Last updated
06/04/2025
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