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
Update your record
If you believe information in your NPPES record is inaccurate, or if you wish to update or deactivate your NPI, you can do so directly with CMS at https://nppes.cms.hhs.gov.
About Stedi
Stedi is the only programmable healthcare clearinghouse. You can use Stedi's APIs to process eligibility checks, claims, remits, and more.
Sign up