Organization
WAL-MART STORES EAST LP
Active
Other names
Wal-Mart Pharmacy 10-2096
Organization subpart
No
Provider details
NPI number
Authorized official
KIMBERLY CANONIC (SENIOR DIRECTOR, ENROLLMENT)
(480) 277-6348
Entity
Organization
Contact information
Practice address
100 E STREET RD, WARMINSTER, PA 18974-3400
(215) 442-5608
Mailing address
702 SW 8TH ST, BENTONVILLE, AR 72716-0445
(479) 277-1238
(479) 277-4331
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
3336C0003X
Community/Retail Pharmacy
Primary
PP481958
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
10074553102758
—
PA
01
—
2122292
PK
—
Enumeration date
10/07/2009
Last updated
06/04/2025
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