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Organization
WAL-MART STORES EAST, LP
Active
Organization
WAL-MART STORES EAST, LP
Active
Other names
Walmart Pharmacy 10-7239
Organization subpart
No
Provider details
NPI number
Authorized official
KIMBERLY CANONIC (SENIOR DIRECTOR, BILLING)
(480) 853-0515
Entity
Organization
Contact information
Practice address
2809 E LAMAR ALEXANDER PKWY, MARYVILLE, TN 37804-3542
(479) 277-3665
Mailing address
1 CUSTOMER DR, BENTONVILLE, AR 72716-0445
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
333600000X
Pharmacy
Primary
—
—
3336C0003X
Community/Retail Pharmacy
—
—
Other
Enumeration date
09/22/2026
Last updated
09/22/2026
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