Organization
WAL-MART STORES EAST LP
Active
Other names
Walmart Pharmacy 10-2465
Organization subpart
No
Provider details
NPI number
Authorized official
KIMBERLY CANONIC (SENIOR DIRECTOR, ENROLLMENT)
(480) 277-6348
Entity
Organization
Contact information
Practice address
3697 WINDSOR SPRING RD, HEPHZIBAH, GA 30815-7192
(706) 691-0571
Mailing address
702 SW 8TH ST, MAILSTOP 0445, BENTONVILLE, AR 72716-0445
(479) 204-8550
(479) 277-4331
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
3336C0003X
Community/Retail Pharmacy
Primary
PHRE010226
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2154725
PK
—
Enumeration date
07/17/2015
Last updated
06/06/2025
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