Organization
WAL-MART STORES EAST LP
Active
Other names
Walmart Pharmacy 10-6207
Organization subpart
No
Provider details
NPI number
Authorized official
KIMBERLY CANONIC (SENIOR DIRECTOR, ENROLLMENT)
(480) 277-6348
Entity
Organization
Contact information
Practice address
14344 SPRING HILL DR, SPRING HILL, FL 34609-8101
(352) 587-6949
(352) 587-6948
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
—
—
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
PH29564
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
016439500
—
FL
05
—
016439501 DME
—
FL
01
—
2154723
PK
—
Enumeration date
09/17/2015
Last updated
06/09/2025
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