Organization
WAL-MART STORES EAST LP
Active
Other names
Walmart Pharmacy 10-2944
Organization subpart
No
Provider details
NPI number
Authorized official
KIMBERLY CANONIC (SENIOR DIRECTOR, ENROLLMENT)
(480) 277-6348
Entity
Organization
Contact information
Practice address
955 S WOODLAND BLVD, DELAND, FL 32720-0000
(386) 624-0679
(386) 624-0680
Mailing address
702 SW 8TH ST, BENTONVILLE, AR 72716-0445
(479) 277-2500
(479) 277-4331
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
333600000X
Pharmacy
Primary
PH31103
FL
3336C0003X
Community/Retail Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
023541600
—
FL
05
—
023541601 DME
—
FL
01
—
2172763
PK
—
Enumeration date
09/08/2017
Last updated
06/09/2025
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