Organization
WAL-MART STORES EAST LP
Active
Other names
WALMART PHARMACY 10-0333
Organization subpart
No
Provider details
NPI number
Authorized official
KIMBERLY CANONIC (SENIOR DIRECTOR, ENROLLMENT)
(480) 277-6348
Entity
Organization
Contact information
Practice address
1701 N MAIN ST, BEAVER DAM, KY 42320-8625
(270) 274-4464
Mailing address
702 SW 8TH ST, BENTONVILLE, AR 72716-0445
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
PO2492
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2031808
PK
—
05
—
5400693700
—
KY
05
—
5402855000
—
KY
Enumeration date
07/16/2006
Last updated
05/30/2025
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