Organization
WAL-MART STORES EAST LP
Active
Other names
Walmart Pharmacy 10-5776
Organization subpart
No
Provider details
NPI number
Authorized official
KIMBERLY CANONIC (SENIOR DIRECTOR, ENROLLMENT)
(480) 277-6348
Entity
Organization
Contact information
Practice address
6412 WASHINGTON AVE, OCEAN SPRINGS, MS 39564-2335
(228) 334-3053
(228) 334-3052
Mailing address
702 SW 8TH ST, MAILSTOP 0445, BENTONVILLE, AR 72716-0445
(479) 204-8550
(479) 277-4331
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
333600000X
Pharmacy
Primary
14836/1.2
MS
3336C0003X
Community/Retail Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2164024
PK
—
Enumeration date
09/19/2016
Last updated
06/10/2025
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