Organization
WAL-MART STORES EAST LP
Active
Other names
WALMART PHARMACY 10-5254
Organization subpart
No
Provider details
NPI number
Authorized official
KIMBERLY CANONIC (SENIOR DIRECTOR, ENROLLMENT)
(480) 853-0515
Entity
Organization
Contact information
Practice address
2114 S MAIN ST, WAKE FOREST, NC 27587-8817
(919) 562-9519
Mailing address
702 SW 8TH ST, BENTONVILLE, AR 72716-0445
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
08498
NC
3336S0011X
Specialty Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0920642
—
NC
01
—
2070301
PK
—
05
—
920642
—
NC
Enumeration date
07/16/2006
Last updated
07/02/2025
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