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 PharmacyCS2735MA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
22037421OTHERPK
3MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1467479758
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 :
Fax Number :
Provider Business Practice Location Address
First Line : 30 MEMORIAL DR
Second Line :
City : AVON
State : MA
Zip : 02322-1919
Country : US
Telephone Number : 508-427-4311
Fax Number :
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 : 06/04/2025

Similar Medicare Providers

1376623710 — WAL-MART STORES EAST, LP
Practice Location Address:
30 MEMORIAL DR
AVON, MA
02322-1919
Practice Phone: 508-427-9460
Practice Fax:
1508938655 — YIN YIN YUEN O.D.
Practice Location Address:
30 MEMORIAL DR
AVON, MA
02322-1919
Practice Phone: 508-587-8391
Practice Fax: 508-587-5317
1508321324 — LINDSAY WILSON PHARMD
Practice Location Address:
30 MEMORIAL DR
AVON, MA
02322-1919
Practice Phone: 508-427-4311
Practice Fax:
1962002063 — CHRISTINE PHAM
Practice Location Address:
30 MEMORIAL DR
AVON, MA
02322-1919
Practice Phone: 508-427-4311
Practice Fax:
1013697051 — ALEXANDER OWEN
Practice Location Address:
30 MEMORIAL DR
AVON, MA
02322-1919
Practice Phone: 508-587-4763
Practice Fax:
1083428692 — ANNA YELKINA-DAMMAN
Practice Location Address:
170 OAKWOOD DR
AVON LAKE, OH
44012-1919
Practice Phone: 440-570-9645
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.