Organization
WAL-MART STORES EAST LP
Active
Other names
WAL-MART PHARMACY 10-2360
Organization subpart
No
Provider details
NPI number
Authorized official
KIMBERLY CANONIC (SENIOR DIRECTOR, ENROLLMENT)
(480) 277-6348
Entity
Organization
Contact information
Practice address
4725 ASHFORD DUNWOODY RD, ATLANTA, GA 30338-5561
(770) 395-7946
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
PHRE007922
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00681304A
—
GA
01
—
2019168
PK
—
Enumeration date
07/16/2006
Last updated
06/02/2025
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