Organization
WAL-MART STORES EAST LP
Active
Other names
WalMart Pharmacy 10-5759
Organization subpart
No
Provider details
NPI number
Authorized official
KIMBERLY CANONIC (SENIOR DIRECTOR, ENROLLMENT)
(480) 853-0515
Entity
Organization
Contact information
Practice address
6177 S JOG RD, LAKE WORTH, FL 33467-6580
(561) 964-0607
Mailing address
702 SW 8TH ST, BENTONVILLE, AR 72716-0445
(479) 277-1238
(479) 277-4331
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
PH23879
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2118434
PK
—
05
—
747100
—
FL
Enumeration date
01/05/2009
Last updated
06/16/2025
About Stedi
Stedi is the only programmable healthcare clearinghouse. You can use Stedi's APIs to process eligibility checks, claims, remits, and more.
Contact us