Organization
WAL-MART STORES EAST LP
Active
Other names
WALMART PHARMACY 10-0303
Organization subpart
No
Provider details
NPI number
Authorized official
KIMBERLY CANONIC (SENIOR DIRECTOR, ENROLLMENT)
(480) 277-6348
Entity
Organization
Contact information
Practice address
950 MACKIE DR, HOLLY SPRINGS, MS 38635-7406
(662) 252-9988
Mailing address
702 SW 8TH ST, MAIL STOP 0445, BENTONVILLE, AR 72716-0445
(479) 277-1242
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
02554
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
09427533
—
MS
01
—
2045414
PK
—
05
—
9427533
—
MS
Enumeration date
07/16/2006
Last updated
05/30/2025
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