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Contact Information

WAL-MART STORES EAST LP
4924 S MAPLE TREE DR
PRINCETON, IN47670-9278
 Phone: 812-385-0757
 Fax: 812-385-0759
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Community/Retail Pharmacy

3336C0003X 58 Medical Supply Company with Pharmacist
 

Durable Medical Equipment & Medical Supplies

332B00000X 54 Other Medical Supply Company
 

Institutional Pharmacy

3336I0012X 58 Medical Supply Company with Pharmacist
Indicates primary specialty

NPI Profile & details for WAL-MART STORES EAST LP

NPI Number 1053747071
LBN Legal business name WAL-MART STORES EAST LP
Authorized official KIMBERLY CANONIC - (SENIOR DIRECTOR, ENROLLMENT)
Entity Organization
Organization subpart 1 No
Enumeration date 09/23/2013
Last updated 06/10/2025 - About 12 months ago
Identifiers
IN License # 60006362A
Other 2142896 PK
1 Some organization health care providers are made up of components that furnish different types of health care or have separate physical locations where health care is furnished. These components and physical locations are not themselves legal entities, but are part of the organization health care provider (which is a legal entity). A covered organization provider may decide that its subparts (if it has any) should have their own NPI numbers. If a subpart conducts any HIPAA standard transactions on its own (e.g., separately from its parent), it must obtain its own NPI number.

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