Organization
WAL-MART STORES EAST LP
Active
Other names
Walmart Pharmacy 10-4237
Organization subpart
No
Provider details
NPI number
Authorized official
KIMBERLY CANONIC (SENIOR DIRECTOR ENROLLMENT)
(480) 853-0515
Entity
Organization
Contact information
Practice address
10048 CHARLOTTE HWY, INDIAN LAND, SC 29707-7135
(803) 802-1818
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
11086
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2125807
PK
—
05
—
711087
—
SC
Enumeration date
06/28/2010
Last updated
07/14/2025
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