National Provider Identifier Database

WAL MART STORES EAST LP
Community/Retail Pharmacy

A pharmacy where pharmacists store, prepare, and dispense medicinal preparations and/or prescriptions for a local patient population in accordance with federal and state law; counsel patients and caregivers (sometimes independent of the dispensing process); administer vaccinations; and provide other professional services associated with pharmaceutical care such as health screenings, consultative services with other health care providers, collaborative practice, disease state management, and education classes.


Contact Information

WAL-MART STORES EAST LP
10305 COUNTRY CLUB ROAD
IRONWOOD, MI49938
Phone: 906-932-4191
Fax:
Website:
Specialty Taxonomy Code
* Community/Retail Pharmacy 3336C0003X
Durable Medical Equipment & Medical Supplies 332B00000X

* Indicates primary specialty

NPI Profile & details for WAL-MART STORES EAST LP

NPI Number 1740466176
Legal business name
LBN
WAL-MART STORES EAST LP
Authorized official KIMBERLY CANONIC - (SENIOR DIRECTOR, ENROLLMENT)
Entity Organization
Organization subpart No
Enumeration date 01/16/2008
Last updated 06/13/2025 - About 12 months ago
Sole proprietor1 Not specified
Identifiers
  • MI License #: 5301008794
  • MI Medicaid: 3270827
  • WI Medicaid: 36226800
  • Other: 2043626 PK

1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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