Organization
WAL-MART STORES EAST LP
Active
Other names
Walmart Pharmacy 10-6978
Organization subpart
No
Provider details
NPI number
Authorized official
KIMBERLY CANONIC (DIRECTOR, ENROLLMENT SERVICES)
(480) 277-6348
Entity
Organization
Contact information
Practice address
7075 COLLINS RD, JACKSONVILLE, FL 32244-5041
(904) 365-2552
Mailing address
702 SW 8TH ST, BENTONVILLE, AR 72716-0445
(479) 277-1242
(479) 277-4331
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
333600000X
Pharmacy
Primary
PH29981
FL
3336C0003X
Community/Retail Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
017210600
—
FL
05
—
017210601
—
FL
01
—
2159271
PK
—
Enumeration date
04/01/2016
Last updated
06/10/2025
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