Organization
WAL-MART STORES EAST LP
Active
Other names
Walmart Pharmacy 10-5393
Organization subpart
No
Provider details
NPI number
Authorized official
KIMBERLY CANONIC (SENIOR DIRECTOR, ENROLLMENT)
(480) 853-0515
Entity
Organization
Contact information
Practice address
1050 ALAMANCE CHURCH RD, GREENSBORO, NC 27406-3808
(336) 291-0566
(336) 291-0565
Mailing address
702 SW 8TH ST, MAILSTOP 0445, BENTONVILLE, AR 72716-0445
(479) 204-8550
(479) 277-4331
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
12748
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1457722084 NPI
—
NC
01
—
2155180
PK
—
Enumeration date
10/08/2015
Last updated
06/12/2025
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