Organization
WAL-MART STORES EAST LP
Active
Other names
WAL-MART PHARMACY 10-3783
Organization subpart
No
Provider details
NPI number
Authorized official
KIMBERLY CANONIC (SENIOR DIRECTOR, ENROLLMENT)
(480) 277-6348
Entity
Organization
Contact information
Practice address
3465 YORK COMMONS BLVD, DAYTON, OH 45414-2675
(937) 454-6290
Mailing address
702 SW 8TH ST, BENTONVILLE, AR 72716-0445
(479) 277-1242
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
3336C0003X
Community/Retail Pharmacy
Primary
021589900
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2080398
PK
—
05
—
2692395
—
OH
Enumeration date
06/12/2006
Last updated
07/08/2025
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