Organization
WAL-MART STORES EAST LP
Active
Other names
WALMART PHARMACY 10-1868
Organization subpart
No
Provider details
NPI number
Authorized official
KIMBERLY CANONIC (SENIOR DIRECTOR, ENROLLMENT)
(480) 853-0515
Entity
Organization
Contact information
Practice address
100 MOUNT AUBURN AVE, AUBURN, ME 04210-8651
(207) 784-1244
(479) 277-4331
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
PH50001138
ME
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
187470018
—
ME
01
—
2036815
PK
—
05
—
999101071
—
ME
Enumeration date
07/16/2006
Last updated
06/12/2025
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