Organization
WAL-MART STORES EAST LP
Active
Other names
Wal-Mart Pharmacy 10-2488
Organization subpart
No
Provider details
NPI number
Authorized official
KIMBERLY CANONIC (SENIOR DIRECTOR, ENROLLMENT)
(480) 277-6348
Entity
Organization
Contact information
Practice address
1203 6TH AVE SE, DECATUR, AL 35601-4011
(256) 822-6366
Mailing address
702 SW 8TH ST, BENTONVILLE, AR 72716-0445
(479) 204-6375
(479) 277-4331
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
3336C0003X
Community/Retail Pharmacy
Primary
114080
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
148450
—
AL
05
—
187589 DME
—
AL
01
—
2139345
PK
—
Enumeration date
03/06/2013
Last updated
06/06/2025
About Stedi
Stedi is the only programmable healthcare clearinghouse. You can use Stedi's APIs to process eligibility checks, claims, remits, and more.
Contact us