# WAL-MART STORES EAST LP

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Walmart Pharmacy 10-7188
- **Organization subpart:** No

## Provider details

- **NPI number:** 1174985246
- **Authorized official:** KIMBERLY CANONIC (SENIOR DIRECTOR, ENROLLMENT)
- **Authorized official phone:** (480) 277-6348

## Contact information

- **Practice address:** 251 ANDOVER PL, DARLINGTON, SC 29532-1500
- **Practice address phone:** (843) 395-8467
- **Practice address fax:** (843) 395-8469
- **Mailing address:** 702 SW 8TH ST, MAILSTOP 0445, BENTONVILLE, AR 72716-0445
- **Mailing address phone:** (479) 204-8550
- **Mailing address fax:** (479) 277-4331

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 332B00000X | Durable Medical Equipment & Medical Supplies | — | NULL | — |
| 333600000X | Pharmacy | — | NULL | — |
| 3336C0003X | Community/Retail Pharmacy | 16540 | SC | Yes |

## Other

- **Enumeration date:** 03/28/2016
- **Last updated:** 06/09/2025

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 2159086 | PK | — |
| 05 | — | 716540 | — | SC |