Organization
WAL-MART STORES EAST LP
Active
Other names
WALMART PHARMACY 10-3463
Organization subpart
No
Provider details
NPI number
Authorized official
KIMBERLY CANONIC (SENIOR DIRECTOR, ENROLLMENT)
(480) 853-0515
Entity
Organization
Contact information
Practice address
1208 E BRANDON BLVD, BRANDON, FL 33511-5529
(813) 643-5885
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
PH18695
FL
3336S0011X
Specialty Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
015964000
—
FL
05
—
015964001
—
FL
01
—
2014725
PK
—
Enumeration date
07/19/2006
Last updated
06/19/2025
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