Organization
WAL-MART STORES EAST LP
Active
Other names
WALMART PHARMACY 10-4384
Organization subpart
No
Provider details
NPI number
Authorized official
KIMBERLY CANONIC (SENIOR DIRECTOR, ENROLLMENT)
(480) 853-0515
Entity
Organization
Contact information
Practice address
3000 PROPRIETORS PL, MT PLEASANT, SC 29466-8361
(843) 884-2824
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
9574
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2093398
PK
—
05
—
795746
—
SC
05
—
DE2985
—
SC
Enumeration date
07/13/2007
Last updated
07/10/2025
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