Organization · NPI-2

Wal-Mart Stores East LP

Pharmacy, Community/Retail Pharmacy · Beavercreek, OH

NPI number1720005911
StatusActive
Last updated in NPPESJun 3, 2025

Details

NPI
1720005911
Entity type
Organization (NPI-2)
Legal business name
Wal-Mart Stores East LP
Organization subpart
No
Enumeration date
Jul 16, 2006
Certification date
Jun 3, 2025
Last updated
Jun 3, 2025

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
3336C0003X Pharmacy, Community/Retail Pharmacy020766550OHYes
332B00000X Durable Medical Equipment & Medical Supplies––
333600000X Pharmacy––

Other names

  • Wal-Mart Pharmacy 10-2124 (Doing Business As)

Practice location

3360 Pentagon Blvd
Beavercreek, OH 45431-1702

Phone 937-426-7007 · Fax 937-427-8402

Mailing address

702 Sw 8th St
Bentonville, AR 72716-0445

Authorized official

Kimberly Canonic
Senior Director, Enrollment
4802776348

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