Organization
WAL-MART STORES EAST LP
Active
Other names
WALMART PHARMACY 10-0801
Organization subpart
No
Provider details
NPI number
Authorized official
KIMBERLY CANONIC (SENIOR DIRECTOR, ENROLLMENT)
(480) 277-6348
Entity
Organization
Contact information
Practice address
1605 S MAIN ST, MARYVILLE, MO 64468-2611
(660) 562-3593
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
—
—
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
2002009470
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2050644
PK
—
05
—
602167405
—
MO
Enumeration date
07/16/2006
Last updated
06/03/2025
About Stedi
Stedi is the only programmable healthcare clearinghouse. You can use Stedi's APIs to process eligibility checks, claims, remits, and more.
Contact us