Organization
WAL-MART STORES EAST LP
Active
Other names
WALMART PHARMACY 10-0742
Organization subpart
No
Provider details
NPI number
Authorized official
KIMBERLY CANONIC (SENIOR DIRECTOR, ENROLLMENT)
(480) 277-6348
Entity
Organization
Contact information
Practice address
2500 W STONE DR, KINGSPORT, TN 37660-2356
(423) 245-0866
(423) 245-8506
Mailing address
702 SW 8TH ST, 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
C2288
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1454061
—
TN
01
—
2091298
PK
—
Enumeration date
07/16/2006
Last updated
06/03/2025
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