DataLabs
datalabs.health made in the usa
DataLabs Facebook Wall   Like   Follow DataLabs on Twitter   Tweet  
Contact us Sign in |  Documentation | 
NPI Code Detail

MEDICARE: WAL-MART STORES EAST LP

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
1332B00000XDurable Medical Equipment & Medical Supplies
2333600000XPharmacy
33336C0003XCommunity/Retail PharmacyPH29983FL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
12158162OTHERPK
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1366801839
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 : MAILSTOP 0445
City : BENTONVILLE
State : AR
Zip : 72716-0445
Country : US
Telephone Number : 479-204-8550
Fax Number : 479-277-4331
Provider Business Practice Location Address
First Line : 301 S STATE ROAD 7
Second Line :
City : HOLLYWOOD
State : FL
Zip : 33023-6756
Country : US
Telephone Number : 754-260-6711
Fax Number : 754-260-6710
Authorized Official
Title or Position : SENIOR DIRECTOR, ENROLLMENT
Name : KIMBERLY CANONIC
Credential :
Telephone Number : 480-277-6348
Provider Enumeration Date : 02/12/2016
Last Update Date : 06/06/2025

Similar Medicare Providers

1902371800 — JADE INDIRA JACKSON
Practice Location Address:
301 S STATE ROAD 7
HOLLYWOOD, FL
33023-6756
Practice Phone: 754-260-6711
Practice Fax:
1932709748 — JOANNA RODRIGUEZ
Practice Location Address:
301 S STATE ROAD 7
HOLLYWOOD, FL
33023-6756
Practice Phone: 754-260-6711
Practice Fax: 754-260-6710
1750982005 — MRS. IRINA GONZALEZ PHARM.D
Practice Location Address:
301 S STATE ROAD 7
HOLLYWOOD, FL
33023-6756
Practice Phone: 786-390-1995
Practice Fax:
1881289023 — ROUDELYNE BASTIEN
Practice Location Address:
301 S STATE ROAD 7
HOLLYWOOD, FL
33023-6756
Practice Phone: 754-260-6711
Practice Fax:
1043097603 — TONIKA LOVONE
Practice Location Address:
301 S STATE ROAD 7
HOLLYWOOD, FL
33023-6756
Practice Phone: 754-260-6709
Practice Fax:
1477419877 — KIESHA ZEPHIRIN-BELLE
Practice Location Address:
301 S STATE ROAD 7
HOLLYWOOD, FL
33023-6756
Practice Phone: 754-760-7211
Practice Fax:

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.