Organization
WAL-MART STORES EAST LP
Active
Other names
Wal-Mart Pharmacy 10-3192
Organization subpart
No
Provider details
NPI number
Authorized official
KIMBERLY CANONIC (SENIOR DIRECTOR, ENROLLMENT)
(480) 277-6348
Entity
Organization
Contact information
Practice address
11410 ANDERSON RD, GREENVILLE, SC 29611-7502
(864) 269-4338
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
14384
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2138857
PK
—
05
—
714384
—
SC
Enumeration date
01/31/2013
Last updated
06/05/2025
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