Organization
WAL-MART STORES EAST LP
Active
Other names
WalMart Pharmacy 10-4623
Organization subpart
No
Provider details
NPI number
Authorized official
KIMBERLY CANONIC (SENIOR DIRECTOR, ENROLLMENT)
(480) 853-0515
Entity
Organization
Contact information
Practice address
6111 JEFFERSON AVE, NEWPORT NEWS, VA 23605-1511
(757) 637-4217
Mailing address
702 SW 8TH ST, BENTONVILLE, AR 72716-0445
(479) 204-0709
(479) 277-4331
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
0201004494
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1144564782
—
VA
01
—
2138057
PK
—
Enumeration date
11/20/2012
Last updated
06/18/2025
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