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 Pharmacy2002009664MO

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
12047171OTHERPK
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1770500035
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 : 18401 BUSINESS 13
Second Line :
City : REEDS SPRING
State : MO
Zip : 65737-9609
Country : US
Telephone Number : 417-272-8050
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

1043284730 — ELIZABETH J BALLARD MD
Practice Location Address:
18452 BUSINESS 13
BRANSON WEST, MO
65737-9609
Practice Phone: 417-272-8911
Practice Fax: 417-272-3900
1275571986 — CONNIE ANN BERGLUND FNP
Practice Location Address:
18452 BUSINESS 13
BRANSON WEST, MO
65737-9609
Practice Phone: 417-272-8911
Practice Fax: 417-272-3910
1326057977 — SANDRA SUE BEST MSW,LCSW
Practice Location Address:
18452 BUSINESS 13
BRANSON WEST, MO
65737-9609
Practice Phone: 417-272-8911
Practice Fax: 417-272-3900
1497866099 — DR. MATTHEW L COBB MD
Practice Location Address:
18452 BUSINESS 13
BRANSON WEST, MO
65737-9609
Practice Phone: 417-292-8911
Practice Fax: 417-272-3900
1104918457 — DR. THOMAS J LEGG D.O.
Practice Location Address:
18452 BUSINESS 13
BRANSON WEST, MO
65737-9609
Practice Phone: 417-272-8911
Practice Fax:
1861573362 — WAL-MART STORES EAST, LP
Practice Location Address:
18401 STATE HIGHWAY 13
BRANSON WEST, MO
65737-9609
Practice Phone: 417-272-8044
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.