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	2002009482	MO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	2050502	OTHER		PK

General Provider Information

NPI Number	:	1770501249
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	:	1661 JUNGERMANN RD
Second Line	:
City	:	SAINT PETERS
State	:	MO
Zip	:	63304-2821
Country	:	US
Telephone Number	:	636-447-7740
Fax Number	:

Authorized Official
Title or Position	:	SENIOR DIRECTOR, ENROLLMENT
Name	:	KIMBERLY CANONIC
Credential	:
Telephone Number	:	480-277-6348

Provider Enumeration Date	:	07/17/2006
Last Update Date	:	06/03/2025

Similar Medicare Providers

1326046087 — DR. ROBERT ELLIS VANGILDER JR. O.D.
Practice Location Address:

1661 JUNGERMANN RD
SAINT PETERS, MO
63304-2821

Practice Phone: 636-447-9772
Practice Fax: 636-447-6476

1114001740 — WAL-MART STORES EAST, LP
Practice Location Address:

1661 JUNGERMANN RD
SAINT PETERS, MO
63304-2821

Practice Phone: 636-447-4450
Practice Fax:

1083997159 — MR. CHRISTOPHER L HOWARD RPH
Practice Location Address:

1661 JUNGERMANN RD
SAINT PETERS, MO
63304-2821

Practice Phone: 636-447-7740
Practice Fax:

1205235355 — MRS. KIMBERLY L. KOONTZ NP-C
Practice Location Address:

1615 JUNGERMANN RD
SAINT PETERS, MO
63304-2821

Practice Phone: 636-800-2157
Practice Fax: 636-800-2159

1174087563 — OUR URGENT CARE, LLC
Practice Location Address:

1615 JUNGERMANN RD
SAINT PETERS, MO
63304-2821

Practice Phone: 636-452-5818
Practice Fax: 636-875-7477

1396397154 — MEGAN KRISTINE MILLER PHARMD
Practice Location Address:

1661 JUNGERMANN RD
SAINT PETERS, MO
63304-2821

Practice Phone: 636-447-7740
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.