Organization
WAL-MART STORES EAST LP
Active
Other names
WALMART PHARMACY 10-5444
Organization subpart
No
Provider details
NPI number
Authorized official
KIMBERLY CANONIC (SENIOR DIRECTOR, ENROLLMENT)
(480) 853-0515
Entity
Organization
Contact information
Practice address
10305 COUNTRY CLUB ROAD, IRONWOOD, MI 49938
(906) 932-4191
Mailing address
702 SW 8TH ST, BENTONVILLE, AR 72716-0445
(479) 204-8550
(479) 277-4331
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
3336C0003X
Community/Retail Pharmacy
Primary
5301008794
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2043626
PK
—
05
—
3270827
—
MI
05
—
36226800
—
WI
Enumeration date
01/16/2008
Last updated
06/13/2025
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