Organization
WAL-MART STORES EAST LP
Active
Other names
Walmart Pharmacy 10-5907
Organization subpart
No
Provider details
NPI number
Authorized official
KIMBERLY CANONIC (SENIOR DIRECTOR, ENROLLMENT)
(480) 277-6348
Entity
Organization
Contact information
Practice address
4909 BUENA VISTA RD, COLUMBUS, GA 31907-5015
(706) 223-6573
(706) 223-6572
Mailing address
702 SW 8TH ST, MAILSTOP 0445, BENTONVILLE, AR 72716-0445
(479) 277-1242
(479) 277-4331
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
PHRE010278
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
003174804A
—
GA
05
—
215079
—
AL
01
—
2158156
PK
—
Enumeration date
02/12/2016
Last updated
06/10/2025
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