Organization
WAL-MART STORES EAST LP
Active
Other names
WAL-MART PHARMACY 10-1751
Organization subpart
No
Provider details
NPI number
Authorized official
KIMBERLY CANONIC (SENIOR DIRECTOR, ENROLLMENT)
(480) 853-0515
Entity
Organization
Contact information
Practice address
6600 GLENWOOD AVE, RALEIGH, NC 27612-7128
(919) 783-9693
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
7999
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0928424
—
NC
01
—
2070336
PK
—
05
—
7704114
—
NC
05
—
928424
—
NC
Enumeration date
07/16/2006
Last updated
06/17/2025
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