Organization
WAL-MART STORES EAST LP
Active
Other names
WALMART PHARMACY 10-1048
Organization subpart
No
Provider details
NPI number
Authorized official
KIMBERLY CANONIC (SENIOR DIRECTOR, ENROLLMENT)
(480) 277-6348
Entity
Organization
Contact information
Practice address
589 W HIGHWAY 92, WILLIAMSBURG, KY 40769-1684
(606) 549-4087
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
P02015
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2030643
PK
—
05
—
5400724000
—
KY
05
—
5402218100
—
KY
Enumeration date
07/17/2006
Last updated
06/04/2025
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