Organization
WAL-MART STORES EAST LP
Active
Other names
WalMart Pharmacy 10-5787
Organization subpart
No
Provider details
NPI number
Authorized official
KIMBERLY CANONIC (SENIOR DIRECTOR, ENROLLMENT)
(480) 853-0515
Entity
Organization
Contact information
Practice address
4545 FAYETTEVILLE RD, RAEFORD, NC 28376-7998
(910) 848-2564
Mailing address
702 SW 8TH ST, BENTONVILLE, AR 72716-0445
(479) 277-1238
(479) 277-4331
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
3336C0003X
Community/Retail Pharmacy
Primary
10540
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2125157
PK
—
Enumeration date
05/13/2010
Last updated
06/16/2025
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