Organization
WAL-MART STORES EAST LP
Active
Other names
WALMART PHARMACY 10-0948
Organization subpart
No
Provider details
NPI number
Authorized official
KIMBERLY CANONIC (SENIOR DIRECTOR, ENROLLMENT)
(480) 277-6348
Entity
Organization
Contact information
Practice address
2525 US HIGHWAY 70 SE, HICKORY, NC 28602-8302
(828) 327-7891
Mailing address
702 SW 8TH ST, BENTONVILLE, AR 72716-0445
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
7971
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0185660
—
NC
05
—
185660
—
NC
01
—
2069549
PK
—
Enumeration date
07/18/2006
Last updated
06/04/2025
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