Organization
WAL-MART STORES EAST LP
Active
Other names
Walmart Pharmacy 10-1724
Organization subpart
No
Provider details
NPI number
Authorized official
KIMBERLY CANONIC (SENIOR DIRECTOR, ENROLLMENT)
(480) 853-0515
Entity
Organization
Contact information
Practice address
1640 S WASHINGTON ST, MILLERSBURG, OH 44654-8901
(330) 674-2884
Mailing address
702 SW 8TH ST, BENTONVILLE, AR 72716-0445
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
020678800
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0847801
—
OH
01
—
2072222
PK
—
05
—
847801
—
OH
Enumeration date
07/16/2006
Last updated
06/18/2025
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