Organization
WAL-MART STORES EAST, LP
Active
Other names
Walmart Pharmacy 10-3913
Organization subpart
No
Provider details
NPI number
Authorized official
KIMBERLY CANONIC (SENIOR DIRECTOR, ENROLLMENT)
(480) 853-0515
Entity
Organization
Contact information
Practice address
1200 MAGNOLIA WAY, BLUE SPRINGS, MS 38828-6000
(479) 277-2500
Mailing address
1 CUSTOMER DR, BENTONVILLE, AR 72716-0445
(479) 277-2500
(479) 277-4331
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200017758
—
MS
Enumeration date
05/02/2019
Last updated
04/13/2026
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