Organization
WAL-MART STORES EAST LP
Active
Other names
Walmart Pharmacy 10-6470
Organization subpart
No
Provider details
NPI number
Authorized official
KIMBERLY CANONIC (SENIOR DIRECTOR, ENROLLMENT)
(480) 277-6348
Entity
Organization
Contact information
Practice address
900 W MAIN ST, PLAINFIELD, IN 46168-9407
(317) 204-1386
(317) 204-1387
Mailing address
702 SW 8TH ST, BENTONVILLE, AR 72716-6209
(479) 277-1242
(479) 277-4331
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
3336C0003X
Community/Retail Pharmacy
Primary
60006395A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
201257400 A
—
IN
01
—
2146777
PK
—
Enumeration date
07/03/2014
Last updated
06/09/2025
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