Organization
WAL-MART STORES EAST LP
Active
Other names
Wal-Mart Pharmacy 10-3644
Organization subpart
No
Provider details
NPI number
Authorized official
KIMBERLY CANONIC (SENIOR DIRECTOR, ENROLLMENT)
(480) 277-6348
Entity
Organization
Contact information
Practice address
201 HILLCREST PKWY, CHESAPEAKE, VA 23322-2485
(757) 421-2385
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
0201004400
VA
3336S0011X
Specialty Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1093008690
—
VA
01
—
2130359
PK
—
Enumeration date
05/16/2011
Last updated
07/02/2025
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