# WAL-MART STORES EAST LP

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- **Entity:** Organization
- **Status:** Active
- **Other names:** WalMart Pharmacy 10-4440
- **Organization subpart:** No

## Provider details

- **NPI number:** 1093942906
- **Authorized official:** KIMBERLY CANONIC (SENIOR DIRECTOR, ENROLLMENT)
- **Authorized official phone:** (480) 277-6348

## Contact information

- **Practice address:** 1180 DUTCH FORK RD, IRMO, SC 29063-8874
- **Practice address phone:** (803) 781-7877
- **Mailing address:** 702 SW 8TH ST, BENTONVILLE, AR 72716-0445
- **Mailing address phone:** (479) 277-1242
- **Mailing address fax:** (479) 277-4331

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 332B00000X | Durable Medical Equipment & Medical Supplies | — | NULL | — |
| 3336C0003X | Community/Retail Pharmacy | 10529 | SC | Yes |

## Other

- **Enumeration date:** 06/18/2009
- **Last updated:** 07/11/2025

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 1093942906 | — | SC |
| 01 | — | 2120751 | PK | — |