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	333600000X	Pharmacy
3	3336C0003X	Community/Retail Pharmacy	CS2752	MA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	2037853	OTHER	PK
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1649297946
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	:	780 LYNNWAY
Second Line	:
City	:	LYNN
State	:	MA
Zip	:	01905-3026
Country	:	US
Telephone Number	:	781-592-4330
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	:	06/03/2025

Similar Medicare Providers

1427005248 — NATIONAL VISION, INC.
Practice Location Address:

780 LYNNWAY
LYNN, MA
01905-3026

Practice Phone: 781-599-5755
Practice Fax:

1659347755 — MR. TERRY DUSTON BONNER
Practice Location Address:

609 N BAY DR
LYNN HAVEN, FL
32444-3026

Practice Phone: 850-265-9973
Practice Fax: 850-265-9973

1609882968 — DR. WILLIAM S. CAMPBELL JR. MD
Practice Location Address:

609 N BAY DR
LYNN HAVEN, FL
32444-3026

Practice Phone: 503-813-8478
Practice Fax:

1447674239 — MR. ISAAC OLADIRAN OLATUNDE
Practice Location Address:

243 WESTERN AVE STE 1
LYNN, MA
01904-3026

Practice Phone: 781-780-3566
Practice Fax:

1346696234 — KAREN MARIE STEER SCHIRRIPPA
Practice Location Address:

820 NANCY LYNN LN
ARNOLD, MD
21012-3026

Practice Phone: 410-533-4283
Practice Fax:

1467925966 — VIRAGO PHYSICAL THERAPY, LLC
Practice Location Address:

812 NANCY LYNN LN
ARNOLD, MD
21012-3026

Practice Phone: 443-758-8880
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.