Organization
WAL-MART STORES EAST LP
Active
Other names
Walmart Pharmact 10-3724
Organization subpart
No
Provider details
NPI number
Authorized official
KIMBERLY CANONIC (SENIOR DIRECTOR, ENROLLMENT)
(480) 277-6348
Entity
Organization
Contact information
Practice address
332 STONEWALL JACKSON BLVD, ORANGEBURG, SC 29115-7291
(803) 997-6138
Mailing address
702 SW 8TH ST, MAILSTOP 4550, BENTONVILLE, AR 72716-0445
(479) 277-2500
(479) 277-4331
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
3336C0003X
Community/Retail Pharmacy
Primary
15576
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2148908
PK
—
05
—
715577
—
SC
Enumeration date
10/21/2014
Last updated
06/10/2025
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