Organization
WAL-MART STORES EAST LP
Active
Other names
WAL-MART PHARMACY 10-1710
Organization subpart
No
Provider details
NPI number
Authorized official
KIMBERLY CANONIC (SENIOR DIRECTOR, ENROLLMENT)
(480) 853-0515
Entity
Organization
Contact information
Practice address
950 HIGHWAY 80 E, CLINTON, MS 39056-5203
(601) 924-8778
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
02250
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
08754271
—
MS
01
—
2045331
PK
—
05
—
8754271
—
MS
Enumeration date
07/16/2006
Last updated
06/19/2025
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