Organization
WAL-MART STORES EAST LP
Active
Other names
WalMart Pharmacy 10-5727
Organization subpart
No
Provider details
NPI number
Authorized official
KIMBERLY CANONIC (SENIOR DIRECTOR, ENROLLMENT)
(480) 853-0515
Entity
Organization
Contact information
Practice address
5810 RANCH LAKE BLVD, BRADENTON, FL 34202-3708
(941) 799-5545
Mailing address
702 SW 8TH ST, BENTONVILLE, AR 72716-6209
(479) 277-1238
(479) 277-4331
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
3336C0003X
Community/Retail Pharmacy
Primary
PH26005
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
005793800
—
FL
01
—
2133817
PK
—
Enumeration date
02/03/2012
Last updated
07/07/2025
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