Organization
WAL-MART STORES EAST LP
Active
Other names
WAL-MART PHARMACY 10-3825
Organization subpart
No
Provider details
NPI number
Authorized official
KIMBERLY CANONIC (SENIOR DIRECTOR, ENROLLMENT)
(480) 277-6348
Entity
Organization
Contact information
Practice address
566 US HIGHWAY 70 W, HAVELOCK, NC 28532-9569
(252) 444-0885
Mailing address
702 SW 8TH ST, BENTONVILLE, AR 72716-0445
(479) 277-1242
(479) 277-4331
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
3336C0003X
Community/Retail Pharmacy
Primary
09990
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0255729
—
NC
01
—
2066682
PK
—
Enumeration date
12/05/2007
Last updated
07/08/2025
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