Organization
WAL-MART STORES EAST LP
Active
Other names
WALMART PHARMACY 10-0981
Organization subpart
No
Provider details
NPI number
Authorized official
KIMBERLY CANONIC (SENIOR DIRECTOR, ENROLLMENT)
(480) 277-6348
Entity
Organization
Contact information
Practice address
1733 2ND ST S, MERIDIAN, MS 39301-4514
(601) 485-2218
Mailing address
702 SW 8TH ST, BENTONVILLE, AR 72716-0445
(479) 277-1242
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
19661WM
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00556265
—
MS
01
—
2044978
PK
—
05
—
556265
—
MS
Enumeration date
07/16/2006
Last updated
06/04/2025
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