Organization
WAL-MART STORES EAST LP
Active
Other names
Walmart Pharmacy 10-6941
Organization subpart
No
Provider details
NPI number
Authorized official
KIMBERLY CANONIC (SENIOR DIRECTOR, ENROLLMENT)
(480) 277-6348
Entity
Organization
Contact information
Practice address
2020 NE PINE ISLAND RD, CAPE CORAL, FL 33909-1766
(239) 800-6067
(239) 800-6066
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
Primary
PH30241
FL
3336C0003X
Community/Retail Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
018650300
—
FL
05
—
018650301 DME
—
FL
01
—
2162011
PK
—
Enumeration date
05/27/2016
Last updated
06/10/2025
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