# WAL-MART STORES EAST, LP

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Walmart Pharmacy 10-3913
- **Organization subpart:** No

## Provider details

- **NPI number:** 1669037958
- **Authorized official:** KIMBERLY CANONIC (SENIOR DIRECTOR, ENROLLMENT)
- **Authorized official phone:** (480) 853-0515

## Contact information

- **Practice address:** 1200 MAGNOLIA WAY, BLUE SPRINGS, MS 38828-6000
- **Practice address phone:** (479) 277-2500
- **Mailing address:** 1 CUSTOMER DR, BENTONVILLE, AR 72716-0445
- **Mailing address phone:** (479) 277-2500
- **Mailing address fax:** (479) 277-4331

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 3336C0003X | Community/Retail Pharmacy | — | NULL | Yes |

## Other

- **Enumeration date:** 05/02/2019
- **Last updated:** 04/13/2026

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 200017758 | — | MS |