Organization
WAL-MART STORES EAST LP
Active
Other names
WALMART PHARMACY 10-1795
Organization subpart
No
Provider details
NPI number
Authorized official
KIMBERLY CANONIC (SENIOR DIRECTOR, ENROLLMENT)
(480) 853-0515
Entity
Organization
Contact information
Practice address
177 FOREST GATE DR, PISGAH FOREST, NC 28768-7903
(828) 885-7904
(828) 884-3442
Mailing address
702 SW 8TH ST, BENTONVILLE, AR 72716-0445
(479) 277-1240
(479) 277-4331
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
7997
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0855178
—
NC
01
—
2070385
PK
—
05
—
7704108
—
NC
05
—
855178
—
NC
Enumeration date
07/16/2006
Last updated
06/17/2025
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