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Organization

WAL-MART STORES EAST LP

Active
Other names
Walmart Pharmacy 10-3330
Organization subpart
No

Provider details

NPI number
Authorized official
KIMBERLY CANONIC (SENIOR DIRECTOR, ENROLLMENT)
(480) 277-6348
Entity
Organization

Contact information

Practice address
673 CEDAR RD, CHESAPEAKE, VA 23322-8315
(757) 447-9020
(757) 447-5799
Mailing address
702 SW 8TH ST, MAILSTOP 0445, 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
201004588
VA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
1538579131
VA
01
2146000
PK
Enumeration date
05/05/2014
Last updated
06/09/2025
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