Organization
WAL-MART STORES EAST LP
Active
Organization
WAL-MART STORES EAST LP
Active
Other names
Walmart Pharmacy 10-7290
Organization subpart
No
Provider details
NPI number
Authorized official
KIMBERLY CANONIC (SENIOR DIRECTOR, ENROLLMENT)
(480) 277-6348
Entity
Organization
Contact information
Practice address
6501 VETERANS MEMORIAL PKWY, CRESTWOOD, KY 40014-8694
(502) 241-3959
Mailing address
702 SW 8TH ST, MAILSTOP 0445, BENTONVILLE, AR 72716-0445
(479) 204-1258
(479) 277-4331
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
P07726
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2157812
PK
—
05
—
7100414350
—
KY
Enumeration date
01/07/2016
Last updated
06/10/2025
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