Wal-Mart Stores East LP
NPI #1205079100 in Jefferson City, Missouri
Provider Information
- NPI Number
- 1205079100
- Entity Type
- Organization
- Organization Name
- Wal-Mart Stores East LP
- Primary Specialty
- Pharmacy - Community/Retail Pharmacy
- Enumeration Date
- Apr 8, 2009
- Last Updated
- Jun 13, 2025
Practice Location
- Address
- 401 SUPERCENTER DR
- City
- Jefferson City
- State
- Missouri
- ZIP Code
- 65101-8190
- Phone
- (573) 635-3877
Authorized Official
- Name
- KIMBERLY CANONIC
- Title
- SENIOR DIRECTOR, ENROLLMENT
- Phone
- (480) 853-0515
Specialties & Taxonomy Codes
| Specialty |
|---|
| Durable Medical Equipment & Medical Supplies |
| Pharmacy - Community/Retail Pharmacy — Community/Retail Pharmacy |
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