Organization
WAL-MART STORES EAST LP
Active
Other names
WAL-MART PHARMACY 10-3701
Organization subpart
No
Provider details
NPI number
Authorized official
KIMBERLY CANONIC (SENIOR DIRECTOR, ENROLLMENT)
(480) 277-6348
Entity
Organization
Contact information
Practice address
308 NC HIGHWAY 55 W, MOUNT OLIVE, NC 28365-8526
(919) 658-2608
Mailing address
702 SW 8TH ST, BENTONVILLE, AR 72716-0445
(479) 277-1242
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
3336C0003X
Community/Retail Pharmacy
Primary
09524
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0965741
—
NC
01
—
2066224
PK
—
Enumeration date
04/19/2007
Last updated
07/07/2025
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