Organization
WAL-MART STORES EAST LP
Active
Other names
WALMART PHARMACY 10-4332
Organization subpart
No
Provider details
NPI number
Authorized official
KIMBERLY CANONIC (SENIOR DIRECTOR, ENROLLMENT)
(480) 853-0515
Entity
Organization
Contact information
Practice address
8990 TURKEY LAKE RD, ORLANDO, FL 32819-7320
(407) 351-2191
(479) 277-4332
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
PH22700
FL
3336S0011X
Specialty Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
032060900
—
FL
01
—
2009121
PK
—
Enumeration date
05/21/2007
Last updated
07/09/2025
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