Organization
WAL-MART STORES EAST LP
Active
Other names
Wal-Mart Pharmacy 10-2332
Organization subpart
No
Provider details
NPI number
Authorized official
KIMBERLY CANONIC (SENIOR DIRECTOR, ENROLLMENT)
(480) 853-0515
Entity
Organization
Contact information
Practice address
700 TUCKERS WAY, SAINT ALBANS, VT 05478-2628
(802) 528-4118
Mailing address
702 SW 8TH ST, BENTONVILLE, AR 72716-0445
(479) 277-2500
(479) 277-4331
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
3336C0003X
Community/Retail Pharmacy
Primary
038.0097171
VT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1022411
—
VT
01
—
2141678
PK
—
Enumeration date
08/14/2013
Last updated
06/18/2025
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