Organization
WAL-MART STORES EAST LP
Active
Other names
Walmart Pharmacy 10-3299
Organization subpart
No
Provider details
NPI number
Authorized official
KIMBERLY CANONIC (SENIOR DIRECTOR, ENROLLMENT)
(480) 277-6348
Entity
Organization
Contact information
Practice address
475 KEMPSVILLE RD, CHESAPEAKE, VA 23320-3721
(757) 447-9224
(757) 447-9225
Mailing address
1 CUSTOMER DR, MAILSTOP 0445, BENTONVILLE, AR 72716-0445
(479) 371-1168
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
3336C0003X
Community/Retail Pharmacy
Primary
0201004600
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1467868521
—
VA
01
—
2146982
PK
—
Enumeration date
07/09/2014
Last updated
09/29/2025
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