MEDICARE: WAL-MART STORES EAST LP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332B00000X	Durable Medical Equipment & Medical Supplies
2	3336C0003X	Community/Retail Pharmacy
3	333600000X	Pharmacy	P02055	MD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	2036156	OTHER		PK

General Provider Information

NPI Number	:	1013934397
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WAL-MART STORES EAST LP

Provider Business Mailing Address
First Line	:	702 SW 8TH ST
Second Line	:
City	:	BENTONVILLE
State	:	AR
Zip	:	72716-0445
Country	:	US
Telephone Number	:	479-277-9170
Fax Number	:

Provider Business Practice Location Address
First Line	:	3200 N RIDGE RD
Second Line	:
City	:	ELLICOTT CITY
State	:	MD
Zip	:	21043-3363
Country	:	US
Telephone Number	:	410-418-9703
Fax Number	:	410-480-1732

Authorized Official
Title or Position	:	SENIOR DIRECTOR, ENROLLMENT
Name	:	KIMBERLY CANONIC
Credential	:
Telephone Number	:	480-277-6348

Provider Enumeration Date	:	07/16/2006
Last Update Date	:	05/30/2025

Similar Medicare Providers

1629178223 — BRIDGET A. BLANDINA O.D.
Practice Location Address:

3200 N RIDGE RD
ELLICOTT CITY, MD
21043-3363

Practice Phone: 410-418-5112
Practice Fax:

1972685857 — WAL-MART STORES EAST, LP
Practice Location Address:

3200 N RIDGE RD
ELLICOTT CITY, MD
21043-3363

Practice Phone: 410-418-5780
Practice Fax:

1013034891 — CHETNA KARTIK DESAI D.D.S.
Practice Location Address:

3290 N RIDGE RD , SUITE 180
ELLICOTT CITY, MD
21043-3363

Practice Phone: 410-480-9111
Practice Fax: 410-480-9133

1154541068 — KARTIK J. DESAI MD PC
Practice Location Address:

3290 N RIDGE RD , SUITE 100
ELLICOTT CITY, MD
21043-3363

Practice Phone: 410-313-9292
Practice Fax: 410-313-9293

1659972768 — IFEYINWA NNOLI
Practice Location Address:

3200 N RIDGE RD
ELLICOTT CITY, MD
21043-3363

Practice Phone: 410-418-9703
Practice Fax:

1487255246 — DR. PAULETTE M GLOVER PHARMD
Practice Location Address:

3200 N RIDGE RD
ELLICOTT CITY, MD
21043-3363

Practice Phone: 410-418-9703
Practice Fax: 410-418-9705

Directions to “WAL-MART STORES EAST LP ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.