Organization
WAL-MART STORES EAST LP
Active
Other names
WalMart Pharmacy 10-5969
Organization subpart
No
Provider details
NPI number
Authorized official
KIMBERLY CANONIC (SENIOR DIRECTOR, ENROLLMENT)
(480) 277-6348
Entity
Organization
Contact information
Practice address
4368 CHANTILLY SHOPPING CENTER DR, CHANTILLY, VA 20151-4016
(571) 392-3087
Mailing address
702 SW 8TH ST, BENTONVILLE, AR 72716-6209
(479) 277-1238
(479) 277-4331
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
3336C0003X
Community/Retail Pharmacy
Primary
0201004446
VA
Other
Enumeration date
01/03/2012
Last updated
06/04/2025
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