# WAL-MART STORES EAST LP

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Wal-Mart Pharmacy 10-2332
- **Organization subpart:** No

## Provider details

- **NPI number:** 1922431998
- **Authorized official:** KIMBERLY CANONIC (SENIOR DIRECTOR, ENROLLMENT)
- **Authorized official phone:** (480) 853-0515

## Contact information

- **Practice address:** 700 TUCKERS WAY, SAINT ALBANS, VT 05478-2628
- **Practice address phone:** (802) 528-4118
- **Mailing address:** 702 SW 8TH ST, BENTONVILLE, AR 72716-0445
- **Mailing address phone:** (479) 277-2500
- **Mailing address fax:** (479) 277-4331

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 332B00000X | Durable Medical Equipment & Medical Supplies | — | NULL | — |
| 3336C0003X | Community/Retail Pharmacy | 038.0097171 | VT | Yes |

## Other

- **Enumeration date:** 08/14/2013
- **Last updated:** 06/18/2025

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 1022411 | — | VT |
| 01 | — | 2141678 | PK | — |