Organization
WAL-MART STORES EAST LP
Active
Other names
WALMART PHARMACY 10-3869
Organization subpart
No
Provider details
NPI number
Authorized official
KIMBERLY CANONIC (SENIOR DIRECTOR, ENROLLMENT)
(480) 853-0515
Entity
Organization
Contact information
Practice address
1504 N PARHAM RD, RICHMOND, VA 23229-4621
(804) 270-7050
Mailing address
702 SW 8TH ST, BENTONVILLE, AR 72716-0445
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
3336C0003X
Community/Retail Pharmacy
Primary
0201004124
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
010385521
—
VA
05
—
1124183553
—
VA
01
—
2106159
PK
—
Enumeration date
12/26/2006
Last updated
07/08/2025
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