Organization
WAL-MART STORES EAST LP
Active
Other names
WalMart Pharmacy 10-6226
Organization subpart
No
Provider details
NPI number
Authorized official
KIMBERLY CANONIC (SENIOR DIRECTOR, ENROLLMENT)
(480) 277-6348
Entity
Organization
Contact information
Practice address
1832 KEMPSVILLE RD, SUITE 100, VIRGINIA BEACH, VA 23464-6861
(757) 278-2573
(757) 278-2573
Mailing address
702 SW 8TH ST, 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
0201004597
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1487061453
—
VA
01
—
2146988
PK
—
Enumeration date
07/22/2014
Last updated
06/09/2025
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