Organization
WAL-MART STORES EAST LP
Active
Other names
WALMART PHARMACY 10-0207
Organization subpart
No
Provider details
NPI number
Authorized official
KIMBERLY CANONIC (SENIOR DIRECTOR, ENROLLMENT)
(480) 277-6348
Entity
Organization
Contact information
Practice address
772 S AIRPORT RD, CLEVELAND, OK 74020-4241
(918) 358-5269
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
52-5782
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100239910A
—
OK
01
—
2074199
PK
—
Enumeration date
07/16/2006
Last updated
05/28/2025
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