# WAL-MART STORES EAST LP

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Walmart Pharmacy 10-3899
- **Organization subpart:** No

## Provider details

- **NPI number:** 1679950158
- **Authorized official:** KIMBERLY CANONIC (SENIOR DIRECTOR, ENROLLMENT)
- **Authorized official phone:** (480) 853-0515

## Contact information

- **Practice address:** 215 SAINT JAMES AVE, GOOSE CREEK, SC 29445-2938
- **Practice address phone:** (843) 714-6289
- **Mailing address:** 702 SW 8TH ST, MAILSTOP 0445, BENTONVILLE, AR 72716-0445
- **Mailing address phone:** (479) 277-2500

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 332B00000X | Durable Medical Equipment & Medical Supplies | — | NULL | — |
| 3336C0003X | Community/Retail Pharmacy | 16017 | SC | Yes |

## Other

- **Enumeration date:** 05/04/2015
- **Last updated:** 06/10/2025

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 2151775 | PK | — |
| 05 | — | 716017 | — | SC |