Organization
WAL-MART STORES EAST LP
Active
Other names
WalMart Pharmacy 10-4457
Organization subpart
No
Provider details
NPI number
Authorized official
KIMBERLY CANONIC (SENIOR DIRECTOR, ENROLLMENT)
(480) 853-0515
Entity
Organization
Contact information
Practice address
336 HIGHWAY 9 W, BENNETTSVILLE, SC 29512-2165
(843) 479-0029
Mailing address
702 SW 8TH ST, BENTONVILLE, AR 72716-6209
(479) 277-1238
(479) 277-4331
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
3336C0003X
Community/Retail Pharmacy
Primary
14115
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2135546
PK
—
05
—
714115
—
SC
Enumeration date
06/05/2012
Last updated
07/14/2025
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