Organization
WAL-MART STORES EAST LP
Active
Other names
Wal-Mart Pharmacy 10-3191
Organization subpart
No
Provider details
NPI number
Authorized official
KIMBERLY CANONIC (SENIOR DIRECTOR, ENROLLMENT)
(480) 277-6348
Entity
Organization
Contact information
Practice address
2637 GENTRY MEMORIAL HWY, PICKENS, SC 29671-9429
(864) 605-6617
(864) 878-9158
Mailing address
702 SW 8TH ST, BENTONVILLE, AR 72716-0445
(479) 277-2500
(479) 277-4331
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
3336C0003X
Community/Retail Pharmacy
Primary
14470
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2139329
PK
—
05
—
714470
—
SC
Enumeration date
03/12/2013
Last updated
06/06/2025
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