Organization
WAL-MART STORES EAST LP
Active
Other names
WalMart Pharmacy 10-4497
Organization subpart
No
Provider details
NPI number
Authorized official
KIMBERLY CANONIC (SENIOR DIRECTOR, ENROLLMENT)
(480) 277-6348
Entity
Organization
Contact information
Practice address
1007 RED FARMER DR, HUEYTOWN, AL 35023-1886
(205) 744-9997
Mailing address
702 SW 8TH ST, BENTONVILLE, AR 72716-6209
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
3336C0003X
Community/Retail Pharmacy
Primary
113199
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1518114321
—
AL
01
—
2117038
PK
—
Enumeration date
08/22/2008
Last updated
08/06/2025
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