Organization
WAL-MART STORES EAST , LP
Active
Other names
Walmart Pharmacy 10-5373
Organization subpart
No
Provider details
NPI number
Authorized official
KIMBERLY CANONIC (SENIOR DIRECTOR, ENROLLMENT)
(480) 853-0515
Entity
Organization
Contact information
Practice address
2786 COMMERCIAL BLVD, CHIPPEWA FALLS, WI 54729-5031
(715) 738-2418
(715) 738-2420
Mailing address
702 SW 8TH ST, BENTONVILLE, AR 72716-0445
(479) 204-8550
(479) 277-4331
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
8449-42
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2110221
PK
—
05
—
33280300
—
WI
Enumeration date
07/16/2006
Last updated
06/13/2025
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