Organization
WAL-MART STORES EAST LP
Active
Organization
WAL-MART STORES EAST LP
Active
Other names
WAL-MART PHARMACY 10-3772
Organization subpart
No
Provider details
NPI number
Authorized official
KIMBERLY CANONIC (SENIOR DIRECTOR, ENROLLMENT)
(480) 277-6348
Entity
Organization
Contact information
Practice address
468 TRADE CENTER LN, JONESVILLE, VA 24263-7463
(276) 346-2872
Mailing address
702 SW 8TH ST, BENTONVILLE, AR 72716-0445
(479) 277-1242
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
3336C0003X
Community/Retail Pharmacy
Primary
0201004097
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
010363004
—
VA
05
—
1023126315
—
VA
01
—
2105972
PK
—
Enumeration date
08/27/2006
Last updated
07/08/2025
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