Organization
WAL-MART STORES EAST LP
Active
Other names
Walmart Pharmacy 10-0377
Organization subpart
No
Provider details
NPI number
Authorized official
KIMBERLY CANONIC (SENIOR DIRECTOR, ENROLLMENT)
(480) 277-6348
Entity
Organization
Contact information
Practice address
337 PINEWOOD RD, SUMTER, SC 29150-5442
(803) 305-6237
(803) 305-6236
Mailing address
702 SW 8TH ST, BENTONVILLE, AR 72716-0445
(479) 277-9170
(479) 277-4331
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
333600000X
Pharmacy
Primary
—
—
3336C0003X
Community/Retail Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2173125
PK
—
Enumeration date
10/26/2017
Last updated
05/30/2025
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