Organization
WAL-MART STORES EAST LP
Active
Other names
Walmart Pharmacy 10-7221
Organization subpart
No
Provider details
NPI number
Authorized official
KIMBERLY CANONIC (SENIOR DIRECTOR, ENROLLMENT)
(480) 853-0515
Entity
Organization
Contact information
Practice address
1100 S MAIN ST, NORTH PORT, FL 34287-3500
(941) 240-3086
(941) 240-3081
Mailing address
702 SW 8TH ST, MAILSTOP 0445, BENTONVILLE, AR 72716-0445
(479) 204-8550
(479) 277-4331
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
PH29603
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
016586300
—
FL
05
—
016586301 DME
—
FL
01
—
2155222
PK
—
Enumeration date
10/08/2015
Last updated
06/12/2025
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