Organization
WAL-MART STORES EAST LP
Active
Other names
WalMart Pharmacy 10-5013
Organization subpart
No
Provider details
NPI number
Authorized official
KIMBERLY CANONIC (SENIOR DIRECTOR, ENROLLMENT)
(480) 277-6348
Entity
Organization
Contact information
Practice address
4102 PRECISION WAY, HIGH POINT, NC 27265-8060
(336) 804-6021
(336) 804-6022
Mailing address
702 SW 8TH ST, BENTONVILLE, AR 72716-0445
(479) 277-2500
(479) 277-4331
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
3336C0003X
Community/Retail Pharmacy
Primary
11536
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1538507876
—
NC
01
—
2140951
PK
—
Enumeration date
06/10/2013
Last updated
06/06/2025
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