Organization
WAL-MART STORES EAST LP
Active
Other names
WalMart Pharmacy 10-4145
Organization subpart
No
Provider details
NPI number
Authorized official
KIMBERLY CANONIC (SENIOR DIRECTOR, ENROLLMENT)
(480) 277-6348
Entity
Organization
Contact information
Practice address
805 W WADE HAMPTON BLVD STE B, GREER, SC 29650-1311
(864) 655-6425
Mailing address
702 SW 8TH ST, BENTONVILLE, AR 72716-0445
(479) 204-8550
(479) 277-4331
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
3336C0003X
Community/Retail Pharmacy
Primary
14357
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2138386
PK
—
05
—
714357
—
SC
05
—
DE3506
—
SC
Enumeration date
12/26/2012
Last updated
06/06/2025
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