Organization
WAL-MART STORES EAST, LP
Active
Organization
WAL-MART STORES EAST, LP
Active
Parent organization
WAL-MART STORES, INC.
Other names
Walmart Pharmacy 10-5704
Organization subpart
Yes
Provider details
NPI number
Legal business name
WAL-MART STORES, INC.
Authorized official
KIMBERLY CANONIC (SENIOR DIRECTOR, ENROLLMENT)
(480) 853-0515
Entity
Organization
Contact information
Practice address
3045 SW PORT ST LUCIE BLVD, PORT ST LUCIE, FL 34953-0000
(772) 301-6124
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
—
—
Other
Enumeration date
09/23/2016
Last updated
06/12/2025
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