Organization
WAL-MART STORES EAST LP
Active
Other names
Walmart Pharmacy 10-3137
Organization subpart
No
Provider details
NPI number
Authorized official
KIMBERLY CANONIC (SENIOR DIRECTOR, ENROLLMENT)
(480) 277-6348
Entity
Organization
Contact information
Practice address
7100 HOPGOOD RD, FAIRVIEW, TN 37062
(615) 387-7023
(615) 387-7024
Mailing address
702 SW 8TH ST, BENTONVILLE, AR 72716-6209
(479) 204-0709
(479) 277-4331
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
3336C0003X
Community/Retail Pharmacy
Primary
5262
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2142685
PK
—
Enumeration date
10/11/2013
Last updated
06/06/2025
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