Organization
WAL-MART STORES EAST LP
Active
Other names
Walmart Pharmacy 10-7299
Organization subpart
No
Provider details
NPI number
Authorized official
KIMBERLY CANONIC (SENIOR DIRECTOR, ENROLLMENT)
(480) 277-6348
Entity
Organization
Contact information
Practice address
902 SW SAINT LUCIE WEST BLVD, PORT ST LUCIE, FL 34986-1766
(772) 446-8743
Mailing address
702 SW 8TH ST, BENTONVILLE, AR 72716-0445
(479) 258-6180
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
333600000X
Pharmacy
Primary
PH29886
FL
3336C0003X
Community/Retail Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
016828200
—
AL
05
—
016828201 DME
—
AL
01
—
2158085
PK
—
Enumeration date
01/27/2016
Last updated
06/09/2025
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