Organization
WAL-MART STORES EAST LP
Active
Other names
Walmart Pharmacy 10-7177
Organization subpart
No
Provider details
NPI number
Authorized official
KIMBERLY CANONIC (SENIOR DIRECTOR, ENROLLMENT)
(480) 277-6348
Entity
Organization
Contact information
Practice address
1942 PORT REPUBLIC RD, ROCKINGHAM, VA 22801-3532
(540) 282-6950
(540) 282-6947
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
—
—
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
0201004710
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1285098319
—
VA
01
—
2159716
PK
—
Enumeration date
04/05/2016
Last updated
06/09/2025
About Stedi
Stedi is the only programmable healthcare clearinghouse. You can use Stedi's APIs to process eligibility checks, claims, remits, and more.
Contact us