Organization
WAL-MART STORES EAST LP
Active
Other names
WALMART PHARMACY 10-4506
Organization subpart
No
Provider details
NPI number
Authorized official
KIMBERLY CANONIC (SENIOR DIRECTOR, ENROLLMENT)
(480) 277-6348
Entity
Organization
Contact information
Practice address
321 KILLIAN RD, COLUMBIA, SC 29203-9607
(803) 754-9999
Mailing address
702 SW 8TH ST, BENTONVILLE, AR 72716-0445
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
3336C0003X
Community/Retail Pharmacy
Primary
9847
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2093482
PK
—
05
—
798476
—
SC
Enumeration date
01/16/2008
Last updated
08/06/2025
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