Organization
WAL-MART STORES EAST LP
Active
Other names
WALMART PHARMACY 10-3864
Organization subpart
No
Provider details
NPI number
Authorized official
KIMBERLY CANONIC (SENIOR DIRECTOR, ENROLLMENT)
(480) 853-0515
Entity
Organization
Contact information
Practice address
561 YOPP RD, JACKSONVILLE, NC 28540-3591
(910) 346-5121
(910) 346-5752
Mailing address
702 SW 8TH ST, BENTONVILLE, AR 72716-0445
(479) 277-9170
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
09946
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1578742037
—
NC
05
—
1578742037 DME
—
NC
01
—
2066634
PK
—
Enumeration date
10/31/2007
Last updated
07/08/2025
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