Organization
WAL-MART STORES EAST LP
Active
Other names
Walmart Pharmacy 10-6807
Organization subpart
No
Provider details
NPI number
Authorized official
KIMBERLY CANONIC (SENIOR DIRECTOR, ENROLLMENT)
(480) 277-6348
Entity
Organization
Contact information
Practice address
6727 RALEIGH LAGRANGE RD, MEMPHIS, TN 38134-7017
(901) 498-5327
(901) 498-5338
Mailing address
702 SW 8TH ST, MAILSTOP 0445, BENTONVILLE, AR 72716-0445
(479) 204-8550
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
00005808
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2159391
PK
—
Enumeration date
03/24/2016
Last updated
06/09/2025
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