Organization
WAL-MART STORES EAST LP
Active
Other names
WAL-MART PHARMACY 10-3829
Organization subpart
No
Provider details
NPI number
Authorized official
KIMBERLY CANONIC (SENIOR DIRECTOR, ENROLLMENT)
(480) 277-6348
Entity
Organization
Contact information
Practice address
2915 W MARKET ST, JOHNSON CITY, TN 37604-9086
(423) 434-2969
(423) 434-2906
Mailing address
702 SW 8TH ST, BENTONVILLE, AR 72716-0445
(479) 277-1242
(479) 277-4331
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
3336C0003X
Community/Retail Pharmacy
Primary
4344
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
186315
—
TN
01
—
2095152
PK
—
Enumeration date
12/27/2006
Last updated
07/08/2025
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