Organization
WAL-MART STORES EAST LP
Active
Other names
Walmart Pharmacy 10-4210
Organization subpart
No
Provider details
NPI number
Authorized official
KIMBERLY CANONIC (SENIOR DIRECTOR ENROLLMENT)
(480) 853-0515
Entity
Organization
Contact information
Practice address
1300 N UNIVERSITY BLVD, MOBILE, AL 36618-2632
(251) 586-6232
Mailing address
702 SW 8TH ST, MAILSTOP 0445, 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
114445
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1316341233
—
AL
05
—
186932
—
AL
01
—
2148914
PK
—
Enumeration date
10/21/2014
Last updated
07/09/2025
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