Organization
WAL-MART STORES EAST, LP
Active
Other names
Walmart Pharmacy 10-6397
Organization subpart
No
Provider details
NPI number
Authorized official
KIMBERLY CANONIC (SENIOR DIRECTOR, ENROLLMENT)
(480) 853-0515
Entity
Organization
Contact information
Practice address
15601 SW 127TH AVE, MIAMI, FL 33177-1406
(305) 235-4440
(305) 235-4441
Mailing address
702 SW 8TH ST, BENTONVILLE, AR 72716-0445
(479) 277-2500
(479) 277-4331
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
3336C0003X
Community/Retail Pharmacy
Primary
—
—
3336S0011X
Specialty Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
112365700
—
FL
Enumeration date
09/14/2021
Last updated
06/11/2025
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