Organization
WAL-MART STORES EAST LP
Active
Other names
WALMART PHARMACY 10-3731
Organization subpart
No
Provider details
NPI number
Authorized official
KIMBERLY CANONIC (SENIOR DIRECTOR, ENROLLMENT)
(480) 853-0515
Entity
Organization
Contact information
Practice address
460 NM HIGHWAY 528, BERNALILLO, NM 87004
(505) 771-4877
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
—
—
3336C0003X
Community/Retail Pharmacy
Primary
PH00003004
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2059069
PK
—
05
—
85072036
—
NM
Enumeration date
01/16/2008
Last updated
07/08/2025
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