Organization · Type 2 NPI

Wal-Mart Stores East LP

Community/Retail Pharmacy · Providence, RI

NPI number 1083779409 Active

Practice location

51 Silver Spring St
Providence, RI 02904-2557

Call (401) 272-5340 Map

Mailing address

702 SW 8th St
Bentonville, AR 72716-0445

Specialties and licenses

Taxonomy	Code	License
Durable Medical Equipment & Medical Supplies	332B00000X	None listed
Community/Retail Pharmacy Primary	3336C0003X	PHA00375 (RI)
Specialty Pharmacy	3336S0011X	None listed

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 …

4 other providers at this address

Other community/retail pharmacy providers in Providence

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NPI record

NPI: 1083779409
Entity type: Organization (Type 2)
Issued: Dec 26, 2006
Last updated: Jun 19, 2025
Status: Active

Other names

<unavail>
Wal-Mart Pharmacy 10-3301 · doing business as
Wal-Mart Pharmacy 10-3301 · doing business as

Authorized official

Kimberly Canonic
Senior Director, Enrollment
(480) 853-0515

Verify this record

This page mirrors the public NPPES file. For credentialing or billing, confirm it on the official CMS NPI Registry, and check the license with the state board.

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About NPI 1083779409

Wal-Mart Stores East LP's National Provider Identifier is 1083779409, issued on Dec 26, 2006. The primary taxonomy on file is Community/Retail Pharmacy (3336C0003X), and the practice location is in Providence, RI. The record was last updated on Jun 19, 2025.