Organization
WAL-MART STORES EAST LP
Active
Other names
Walmart Pharmacy 10-6398
Organization subpart
No
Provider details
NPI number
Authorized official
KIMBERLY CANONIC (SENIOR DIRECTOR, ENROLLMENT)
(480) 277-6348
Entity
Organization
Contact information
Practice address
1569 SAXON BLVD, DELTONA, FL 32725-5833
(386) 457-6190
(386) 457-6187
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
—
—
3336C0003X
Community/Retail Pharmacy
Primary
PH29376
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
015772700
—
FL
05
—
015772701DME
—
FL
01
—
2153616
PK
—
Enumeration date
07/01/2015
Last updated
06/09/2025
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