Organization
WAL-MART STORES EAST LP
Active
Other names
Wal-Mart Pharmacy 10-3157
Organization subpart
No
Provider details
NPI number
Authorized official
KIMBERLY CANONIC (SENIOR DIRECTOR, ENROLLMENT)
(480) 277-6348
Entity
Organization
Contact information
Practice address
11214 JEFFERSON AVE, NEWPORT NEWS, VA 23601-2207
(757) 327-7478
Mailing address
702 SW 8TH ST, BENTONVILLE, AR 72716-0445
(479) 204-0709
(479) 277-4331
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
0201004499
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1386988715
—
VA
05
—
1386988715 DME
—
VA
01
—
2138062
PK
—
Enumeration date
11/26/2012
Last updated
06/06/2025
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