Organization
WAL-MART STORES EAST LP
Active
Other names
WALMART PHARMACY 10-0294
Organization subpart
No
Provider details
NPI number
Authorized official
KIMBERLY CANONIC (SENIOR DIRECTOR, ENROLLMENT)
(480) 277-6348
Entity
Organization
Contact information
Practice address
1725 W EVERLY BROTHERS BLVD, CENTRAL CITY, KY 42330-1833
(270) 754-3924
Mailing address
702 SW 8TH ST, BENTONVILLE, AR 72716-0445
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
PO1911
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2030598
PK
—
05
—
5400683800
—
KY
05
—
5402085400
—
KY
Enumeration date
07/16/2006
Last updated
05/29/2025
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