# WAL-MART STORES EAST LP

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Walmart Pharmacy 10-5740
- **Organization subpart:** No

## Provider details

- **NPI number:** 1730558123
- **Authorized official:** KIMBERLY CANONIC (SENIOR DIRECTOR, ENROLLMENT)
- **Authorized official phone:** (480) 853-0515

## Contact information

- **Practice address:** 2570 GOVERNMENT BLVD, MOBILE, AL 36606-1614
- **Practice address phone:** (251) 586-6486
- **Practice address fax:** (251) 586-6482
- **Mailing address:** 702 SW 8TH ST, MAILSTOP 0445, BENTONVILLE, AR 72716-0445
- **Mailing address phone:** (479) 204-8550
- **Mailing address fax:** (479) 277-4331

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 332B00000X | Durable Medical Equipment & Medical Supplies | — | NULL | — |
| 3336C0003X | Community/Retail Pharmacy | 114541 | AL | Yes |

## Other

- **Enumeration date:** 09/16/2015
- **Last updated:** 07/08/2025

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 1730558123 | — | AL |
| 01 | — | 2154298 | PK | — |