Organization
WAL-MART STORES EAST LP
Active
Other names
Wal-Mart Pharmacy 10-3071
Organization subpart
No
Provider details
NPI number
Authorized official
KIMBERLY CANONIC (SENIOR DIRECTOR, ENROLLMENT)
(480) 277-6348
Entity
Organization
Contact information
Practice address
3201 TUCKER NORCROSS RD, TUCKER, GA 30084-2150
(770) 225-6025
(770) 225-6012
Mailing address
702 SW 8TH ST, BENTONVILLE, AR 72716-0445
(479) 204-6375
(479) 277-4331
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
3336C0003X
Community/Retail Pharmacy
Primary
PHRE009929
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
003136632A
—
GA
01
—
2140348
PK
—
Enumeration date
03/25/2013
Last updated
06/05/2025
About Stedi
Stedi is the only programmable healthcare clearinghouse. You can use Stedi's APIs to process eligibility checks, claims, remits, and more.
Contact us