Organization
WAL-MART STORES EAST LP
Active
Other names
Walmart Pharmacy 10-7249
Organization subpart
No
Provider details
NPI number
Authorized official
KIMBERLY CANONIC (SENIOR DIRECTOR, ENROLLMENT)
(480) 277-6348
Entity
Organization
Contact information
Practice address
500 W MOUNT VERNON BLVD, MOUNT VERNON, MO 65712-1920
(417) 461-7028
(417) 461-7032
Mailing address
702 SW 8TH ST, BENTONVILLE, AR 72716-0445
(479) 277-4331
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
3336C0003X
Community/Retail Pharmacy
Primary
2014034399
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1942618517
—
MO
01
—
2147137
PK
—
Enumeration date
07/28/2014
Last updated
06/05/2025
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