Organization
WAL-MART STORES EAST LP
Active
Other names
Wal-Mart Pharmacy 10-4546
Organization subpart
No
Provider details
NPI number
Authorized official
KIMBERLY CANONIC (SENIOR DIRECTOR, ENROLLMENT)
(480) 277-6348
Entity
Organization
Contact information
Practice address
1750 US HIGHWAY 1, VERO BEACH, FL 32960-5545
(772) 410-2642
(772) 410-2641
Mailing address
702 SW 8TH ST, MAIL STOP 0445, BENTONVILLE, AR 72716-0445
(479) 258-6180
(479) 277-4331
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
333600000X
Pharmacy
Primary
PH30696
FL
3336C0003X
Community/Retail Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
020517900
—
FL
05
—
020517901
—
FL
01
—
2167508
PK
—
Enumeration date
10/31/2016
Last updated
06/10/2025
About Stedi
Stedi is the only programmable healthcare clearinghouse. You can use Stedi's APIs to process eligibility checks, claims, remits, and more.
Contact us