Organization
WAL-MART STORES EAST, LP
Active
Other names
Walmart Pharmacy 10-5719
Organization subpart
No
Provider details
NPI number
Authorized official
KIMBERLY CANONIC (SENIOR DIRECTOR, ENROLLMENT)
(480) 853-0515
Entity
Organization
Contact information
Practice address
14720 SW 26TH ST., MIAMI, FL 33185-0000
(479) 277-9170
(479) 277-2500
Mailing address
702 SW 8TH ST, BENTONVILLE, AR 72716-0445
(479) 277-9170
(479) 277-4331
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
3336C0003X
Community/Retail Pharmacy
Primary
—
—
Other
Enumeration date
06/28/2018
Last updated
06/11/2025
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