Organization
WAL-MART STORES EAST LP
Active
Other names
WalMart Pharmacy 10-4250
Organization subpart
No
Provider details
NPI number
Authorized official
KIMBERLY CANONIC (SENIOR DIRECTOR, ENROLLMENT)
(480) 277-6348
Entity
Organization
Contact information
Practice address
1001 SHILOH GLENN DR, MORRISVILLE, NC 27560-5416
(919) 941-5170
Mailing address
702 SW 8TH ST, BENTONVILLE, AR 72716-0445
(479) 277-1242
(479) 277-4331
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
10282
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0920301
—
NC
01
—
2118202
PK
—
Enumeration date
12/03/2008
Last updated
07/09/2025
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