Organization
WAL-MART STORES EAST LP
Active
Other names
Walmart Pharmacy 10-4619
Organization subpart
No
Provider details
NPI number
Authorized official
KIMBERLY CANONIC (SENIOR DIRECTOR, ENROLLMENT)
(480) 853-0515
Entity
Organization
Contact information
Practice address
316 S GLOSTER ST, TUPELO, MS 38801-4748
(662) 350-6920
(662) 350-6919
Mailing address
702 SW 8TH ST, MS 0445, BENTONVILLE, AR 72716-0445
(479) 204-8550
(479) 277-4331
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
14710/1.2
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
03929751
—
MS
01
—
2158941
PK
—
Enumeration date
02/29/2016
Last updated
06/18/2025
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