NPIMap

Organization Active NPI

Wal-Mart Stores East , LP

Doing business as Walmart Pharmacy 10-0472

  • Optician
  • Broken Arrow, OK
National Provider Identifier
1902771173
Registry record updated Oct 8, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
OpticianTaxonomy code 156FX1800X
Legal business name
WAL-MART STORES EAST , LP
Doing business as
Walmart Pharmacy 10-0472
Practice address
2301 W Kenosha St
Broken Arrow, OK 74012-8912
Phone
(918) 505-6908
Fax
(918) 505-6909
NPI assigned
Oct 8, 2025
Last updated
Oct 8, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 8, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Kimberly Canonic
Title
Senior Director
Phone
(479) 371-1168

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Optician 156FX1800X NU Primary
Eyewear Supplier 332H00000X NU

Addresses

Primary practice location

2301 W Kenosha St
Broken Arrow, OK 74012-8912

Mailing address

1 Customer Dr
Bentonville, AR 72716-0445

Other names 1

  • Walmart Pharmacy 10-0472 Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Ability Network4,654 organizations share this tax ID, including this one

Organizations with this tax ID in the same state 14

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

View all 14

Locations

2301 W Kenosha St
Broken Arrow, OK 74012
Phone (918) 259-1600

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1759881600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1759881600000",
    "number": "1902771173",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1 CUSTOMER DR",
            "city": "BENTONVILLE",
            "state": "AR",
            "postal_code": "727160445"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2301 W KENOSHA ST",
            "city": "BROKEN ARROW",
            "state": "OK",
            "postal_code": "740128912",
            "telephone_number": "918-505-6908",
            "fax_number": "918-505-6909"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WAL-MART STORES EAST , LP",
        "organizational_subpart": "NO",
        "enumeration_date": "2025-10-08",
        "last_updated": "2025-10-08",
        "certification_date": "2025-10-08",
        "status": "A",
        "authorized_official_last_name": "CANONIC",
        "authorized_official_first_name": "KIMBERLY",
        "authorized_official_title_or_position": "SENIOR DIRECTOR",
        "authorized_official_telephone_number": "479-371-1168"
    },
    "taxonomies": [
        {
            "code": "156FX1800X",
            "taxonomy_group": "",
            "desc": "Technician/Technologist, Optician",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "332H00000X",
            "taxonomy_group": "",
            "desc": "Eyewear Supplier",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Walmart Pharmacy 10-0472",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Broken Arrow, OK

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 8, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.