Organization
WAL-MART STORES EAST LP
Active
Other names
Walmart Pharmacy 10-5059
Organization subpart
No
Provider details
NPI number
Authorized official
KIMBERLY CANONIC (SENIOR DIRECTOR, ENROLLMENT)
(480) 277-6348
Entity
Organization
Contact information
Practice address
3110 CANTON ST., HOPKINSVILLE, KY 42240-1316
(270) 962-4120
(270) 962-4119
Mailing address
702 SW 8TH ST, MAILSTOP 0445, BENTONVILLE, AR 72716-0445
(479) 204-8550
(479) 204-8550
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
333600000X
Pharmacy
Primary
P07777
KY
3336C0003X
Community/Retail Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2164182
PK
—
Enumeration date
09/15/2016
Last updated
06/10/2025
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