Organization
WAL-MART STORES EAST LP
Active
Other names
WAL-MART PHARMACY 10-2452
Organization subpart
No
Provider details
NPI number
Authorized official
KIMBERLY CANONIC (SENIOR DIRECTOR, ENROLLMENT)
(480) 277-6348
Entity
Organization
Contact information
Practice address
401 E CAPITOL DR, MILWAUKEE, WI 53212-1211
(414) 967-9360
(414) 967-9435
Mailing address
702 SW 8TH ST, BENTONVILLE, AR 72716-0445
(479) 204-8550
(479) 277-4331
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
8158-42
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2109839
PK
—
05
—
33252400
—
WI
Enumeration date
07/16/2006
Last updated
05/30/2025
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