Organization
WAL-MART STORES EAST LP
Active
Other names
Walmart Pharmacy 10-4387
Organization subpart
No
Provider details
NPI number
Authorized official
KIMBERLY CANONIC (SENIOR DIRECTOR, ENROLLMENT)
(480) 853-0515
Entity
Organization
Contact information
Practice address
25 TOBIAS BOLAND WAY, WORCESTER, MA 01607-2103
(774) 314-3162
Mailing address
702 SW 8TH ST, BENTONVILLE, AR 72716-6209
(479) 277-1238
(479) 277-4331
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
3336C0003X
Community/Retail Pharmacy
Primary
DS89724
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2124003
PK
—
Enumeration date
03/02/2010
Last updated
07/10/2025
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