Organization
WAL-MART STORES EAST LP
Active
Other names
WAL-MART PHARMACY 10-3612
Organization subpart
No
Provider details
NPI number
Authorized official
KIMBERLY CANONIC (SENIOR DIRECTOR, ENROLLMENT)
(480) 277-6348
Entity
Organization
Contact information
Practice address
530 S GRAHAM HOPEDALE RD, BURLINGTON, NC 27217-4322
(336) 226-1922
Mailing address
702 SW 8TH ST, 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
09281
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0015026
—
NC
05
—
100003722
—
NC
01
—
2065775
PK
—
05
—
7704509
—
NC
Enumeration date
07/18/2006
Last updated
07/02/2025
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