Organization
WAL-MART STORES EAST LP
Active
Other names
WAL-MART PHARMACY 10-3546
Organization subpart
No
Provider details
NPI number
Authorized official
KIMBERLY CANONIC (SENIOR DIRECTOR, ENROLLMENT)
(480) 277-6348
Entity
Organization
Contact information
Practice address
164 DANBURY RD, NEW MILFORD, CT 06776-4332
(860) 350-4815
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
PCY.0001819
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
004226040
—
CT
05
—
008045138
—
CT
01
—
2002485
PK
—
05
—
940004226040
—
CT
Enumeration date
07/16/2006
Last updated
07/01/2025
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