Organization
WAL-MART STORES EAST LP
Active
Other names
Walmart Pharmacy 10-4390
Organization subpart
No
Provider details
NPI number
Authorized official
KIMBERLY CANONIC (SENIOR DIRECTOR)
(480) 853-0515
Entity
Organization
Contact information
Practice address
1018 N CLEVELAND ST, ENID, OK 73703-3200
(580) 599-6013
(580) 599-6010
Mailing address
1 CUSTOMER DR, BENTONVILLE, AR 72716-0445
(479) 277-2500
(479) 277-4331
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
3336C0003X
Community/Retail Pharmacy
Primary
5-6935
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100231610Y
—
OK
01
—
2149235
PK
—
Enumeration date
12/04/2014
Last updated
04/10/2026
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