Organization
WAL-MART STORES EAST LP
Active
Other names
Walmart Pharmacy 10-7296
Organization subpart
No
Provider details
NPI number
Authorized official
KIMBERLY CANONIC (SENIOR DIRECTOR, ENROLLMENT)
(480) 277-6348
Entity
Organization
Contact information
Practice address
2794 HICKORY BLVD, HUDSON, NC 28638-9101
(828) 572-6019
(818) 572-6020
Mailing address
702 SW 8TH ST, MAILSTOP 0445, BENTONVILLE, AR 72716-6209
(479) 204-8550
(479) 277-4331
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
12631
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1144609611
—
NC
05
—
1144609611 DME
—
NC
01
—
2152266
PK
—
Enumeration date
05/29/2015
Last updated
06/10/2025
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