# WAL-MART STORES EAST LP

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- **Entity:** Organization
- **Status:** Active
- **Other names:** WAL-MART PHARMACY 10-3402
- **Organization subpart:** No

## Provider details

- **NPI number:** 1700970860
- **Authorized official:** KIMBERLY CANONIC (SENIOR DIRECTOR, ENROLLMENT)
- **Authorized official phone:** (480) 853-0515

## Contact information

- **Practice address:** 1400 HUDSON BRIDGE RD, STOCKBRIDGE, GA 30281-5018
- **Practice address phone:** (770) 474-0454
- **Mailing address:** 702 SW 8TH ST, BENTONVILLE, AR 72716-0445

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 332B00000X | Durable Medical Equipment & Medical Supplies | — | NULL | — |
| 3336C0003X | Community/Retail Pharmacy | PHRE009078 | GA | Yes |

## Other

- **Enumeration date:** 10/03/2006
- **Last updated:** 06/19/2025