# WAL-MART STORES EAST LP

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- **Entity:** Organization
- **Status:** Active
- **Other names:** WAL-MART PHARMACY 10-1701
- **Organization subpart:** No

## Provider details

- **NPI number:** 1194742411
- **Authorized official:** KIMBERLY CANONIC (SENIOR DIRECTOR, ENROLLMENT)
- **Authorized official phone:** (480) 853-0515

## Contact information

- **Practice address:** 955 ELBERT ST, ELBERTON, GA 30635-2641
- **Practice address phone:** (706) 283-8735
- **Mailing address:** 702 SW 8TH ST, BENTONVILLE, AR 72716-0445

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 332B00000X | Durable Medical Equipment & Medical Supplies | — | NULL | — |
| 333600000X | Pharmacy | — | NULL | — |
| 3336C0003X | Community/Retail Pharmacy | PHRE007335 | GA | Yes |

## Other

- **Enumeration date:** 07/16/2006
- **Last updated:** 06/19/2025