Organization
WAL-MART STORES EAST LP
Active
Other names
WAL-MART PHARMACY 10-2361
Organization subpart
No
Provider details
NPI number
Authorized official
KIMBERLY CANONIC (SENIOR DIRECTOR, ENROLLMENT)
(480) 277-6348
Entity
Organization
Contact information
Practice address
4572 MEGA ST NW, NORTH CANTON, OH 44720-7098
(330) 305-0037
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
020957700
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0621929
—
OH
01
—
2074464
PK
—
05
—
621929
—
OH
Enumeration date
07/16/2006
Last updated
06/02/2025
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