Organization
WAL-MART STORES EAST, LP
Active
Other names
Walmart Pharmacy 10-3009
Organization subpart
No
Provider details
NPI number
Authorized official
KIMBERLY CANONIC (DIRECTOR OF HEALTH CARE CONTRACTING)
(480) 853-0515
Entity
Organization
Contact information
Practice address
16625 SE 91ST PHILLIPS CT, THE VILLAGES, FL 32162-0094
(352) 561-7765
(352) 561-7754
Mailing address
1 CUSTOMER DR # MS 0445, BENTONVILLE, AR 72716-0445
(479) 396-9842
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
333600000X
Pharmacy
Primary
—
—
3336C0003X
Community/Retail Pharmacy
—
—
Other
Enumeration date
07/28/2026
Last updated
07/28/2026
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