Organization
WAL-MART STORES EAST LP
Active
Other names
WalMart Pharmacy 10-4220
Organization subpart
No
Provider details
NPI number
Authorized official
KIMBERLY CANONIC (SENIOR DIRECTOR ENROLLMENT)
(480) 853-0515
Entity
Organization
Contact information
Practice address
3201 HOLLAND RD, VIRGINIA BEACH, VA 23453-2828
(757) 821-7681
(757) 821-7675
Mailing address
702 SW 8TH ST, 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
0201004519
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1407299910
—
VA
01
—
2140029
PK
—
Enumeration date
04/15/2013
Last updated
07/09/2025
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