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Organization
WAL-MART STORES EAST LP
Active
Organization
WAL-MART STORES EAST LP
Active
Other names
WALMART PHARMACY 10-0728
Organization subpart
No
Provider details
NPI number
Authorized official
KIMBERLY CANONIC (SENIOR DIRECTOR, ENROLLMENT)
(480) 277-6348
Entity
Organization
Contact information
Practice address
25 PEMBROKE DR, HILTON HEAD ISLAND, SC 29926-2259
(843) 681-3010
(843) 681-3018
Mailing address
702 SW 8TH ST, BENTONVILLE, AR 72716-0445
(479) 258-6180
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
NULL
333600000X
Pharmacy
—
NULL
3336C0003X
Community/Retail Pharmacy
Primary
2914
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2090452
PK
—
05
—
729145
—
SC
Enumeration date
07/16/2006
Last updated
06/03/2025
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