# WAL-MART STORES EAST LP

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- **Entity:** Organization
- **Status:** Active
- **Other names:** WalMart Pharmacy 10-5705
- **Organization subpart:** No

## Provider details

- **NPI number:** 1235445222
- **Authorized official:** KIMBERLY CANONIC (SENIOR DIRECTOR, ENROLLMENT)
- **Authorized official phone:** (480) 853-0515

## Contact information

- **Practice address:** 545 GARDEN CITY CONNECTOR, MURRELLS INLET, SC 29576-7847
- **Practice address phone:** (843) 357-6588
- **Mailing address:** 702 SW 8TH ST, BENTONVILLE, AR 72716-6209
- **Mailing address phone:** (479) 277-1238
- **Mailing address fax:** (479) 277-4331

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 332B00000X | Durable Medical Equipment & Medical Supplies | — | NULL | — |
| 3336C0003X | Community/Retail Pharmacy | 11157 | SC | Yes |

## Other

- **Enumeration date:** 08/27/2010
- **Last updated:** 07/07/2025

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 2126649 | PK | — |
| 05 | — | 711157 | — | SC |