Organization
WAL-MART STORES EAST LP
Active
Other names
Walmart Pharmacy 10-7337
Organization subpart
No
Provider details
NPI number
Authorized official
KIMBERLY CANONIC (SENIOR DIRECTOR, ENROLLMENT)
(480) 277-6348
Entity
Organization
Contact information
Practice address
1826 E ARLINGTON BLVD, GREENVILLE, NC 27858-5873
(252) 917-6192
Mailing address
702 SW 8TH ST, MS 0445, BENTONVILLE, AR 72716-6209
(479) 277-2500
(479) 277-4331
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
3336C0003X
Community/Retail Pharmacy
Primary
12528
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1629469838
—
NC
01
—
2150255
PK
—
Enumeration date
02/10/2015
Last updated
06/09/2025
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