Organization
WAL-MART STORES EAST LP
Active
Other names
Wal-Mart Pharmacy 10-5446
Organization subpart
No
Provider details
NPI number
Authorized official
KIMBERLY CANONIC (SENIOR DIRECTOR, ENROLLMENT)
(480) 853-0515
Entity
Organization
Contact information
Practice address
405 MURTHA DR, WAYNESBURG, PA 15370-7010
(724) 627-3546
Mailing address
702 SW 8TH ST, BENTONVILLE, AR 72716-0445
(479) 277-1238
(479) 277-4331
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
PP481907
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1007455310272
—
PA
01
—
2118805
PK
—
Enumeration date
01/27/2009
Last updated
06/13/2025
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