Organization
WAL-MART STORES EAST LP
Active
Other names
WalMart Pharmacy 10-5758
Organization subpart
No
Provider details
NPI number
Authorized official
KIMBERLY CANONIC (SENIOR DIRECTOR, ENROLLMENT)
(480) 853-0515
Entity
Organization
Contact information
Practice address
3911 S JOG RD, GREENACRES, FL 33467-1590
(561) 964-6467
Mailing address
702 SW 8TH ST, BENTONVILLE, AR 72716-6209
(479) 277-1238
(479) 277-4331
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
PH23764
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2118190
PK
—
Enumeration date
12/03/2008
Last updated
06/16/2025
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