Organization
WAL-MART STORES EAST LP
Active
Other names
Walmart Pharmacy 10-5769
Organization subpart
No
Provider details
NPI number
Authorized official
KIMBERLY CANONIC (SENIOR DIRECTOR, ENROLLMENT)
(480) 853-0515
Entity
Organization
Contact information
Practice address
3871 W MAIN ST, DOTHAN, AL 36305-9394
(479) 277-8020
(479) 277-4331
Mailing address
702 SW 8TH ST, BENTONVILLE, AR 72716-0445
(479) 204-1258
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
333600000X
Pharmacy
Primary
114597
AL
3336C0003X
Community/Retail Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
186095
—
AL
05
—
187929 DME
—
AL
01
—
2155735
PK
—
Enumeration date
10/08/2015
Last updated
06/11/2025
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