Organization
WAL-MART STORES EAST LP
Active
Other names
WALMART PHARMACY 10-4318
Organization subpart
No
Provider details
NPI number
Authorized official
KIMBERLY CANONIC (SENIOR DIRECTOR, ENROLLMENT)
(480) 853-0515
Entity
Organization
Contact information
Practice address
145 KELLEY BLVD, MILLBROOK, AL 36054-2200
(334) 285-0322
Mailing address
702 SW 8TH ST, BENTONVILLE, AR 72716-0445
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
3336C0003X
Community/Retail Pharmacy
Primary
112946
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100039122
—
AL
01
—
1996016
PK
—
Enumeration date
05/21/2007
Last updated
07/08/2025
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