# WAL-MART STORES EAST LP

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- **Entity:** Organization
- **Status:** Active
- **Other names:** WAL-MART PHARMACY 10-2939
- **Organization subpart:** No

## Provider details

- **NPI number:** 1548288079
- **Authorized official:** KIMBERLY CANONIC (SR DIRECTOR, CONTRACTING)
- **Authorized official phone:** (479) 371-1168

## Contact information

- **Practice address:** 200 MARKETPLACE DR, RICHLAND, MS 39218-4429
- **Practice address phone:** (601) 939-2958
- **Mailing address:** 1 CUSTOMER DR \# MS 0445, 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 | 05061 | MS | Yes |

## Other

- **Enumeration date:** 07/17/2006
- **Last updated:** 01/26/2026

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 05851031 | — | MS |
| 01 | — | 2046298 | PK | — |
| 05 | — | 5851031 | — | MS |