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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 PharmacyPP414696LPA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
22081425OTHERPK

General Provider Information

NPI Number : 1770500837
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 : 900 COMMERCE BLVD
Second Line :
City : DICKSON CITY
State : PA
Zip : 18519-1767
Country : US
Telephone Number : 570-383-4533
Fax Number :
Authorized Official
Title or Position : SENIOR DIRECTOR, ENROLLMENT
Name : KIMBERLY CANONIC
Credential :
Telephone Number : 480-853-0515
Provider Enumeration Date : 07/16/2006
Last Update Date : 06/12/2025

Similar Medicare Providers

1588874879 — MARISA M MAGHRAN R.PH.
Practice Location Address:
900 COMMERCE BLVD
DICKSON CITY, PA
18519-1767
Practice Phone: 570-383-4533
Practice Fax:
1669604641 — DR. MARY BLAIR LONG O.D.
Practice Location Address:
900 COMMERCE BLVD , VISION CENTER #1884 NEXT TO WALMART
DICKSON CITY, PA
18519-1767
Practice Phone: 570-383-9358
Practice Fax: 570-383-1205
1437471745 — MISS KAREN ANN SPATARO PHARMD
Practice Location Address:
900 COMMERCE BLVD
DICKSON CITY, PA
18519-1767
Practice Phone: 570-383-4533
Practice Fax: 570-383-4529
1720301047 — KAREN DAVIES
Practice Location Address:
900 COMMERCE BLVD
DICKSON CITY, PA
18519-1767
Practice Phone: 610-220-1019
Practice Fax:
1679896765 — STEVEN R ADEL RPH
Practice Location Address:
900 COMMERCE BLVD
DICKSON CITY, PA
18519-1767
Practice Phone: 570-383-4533
Practice Fax:
1801663265 — WAL-MART STORES EAST, LP.
Practice Location Address:
900 COMMERCE BLVD
DICKSON CITY, PA
18519-1767
Practice Phone: 570-383-9358
Practice Fax: 570-383-1205

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

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