Organization
WAL-MART STORES EAST LP
Active
Other names
WALMART PHARMACY 10-5488
Organization subpart
No
Provider details
NPI number
Authorized official
KIMBERLY CANONIC (SENIOR DIRECTOR, ENROLLMENT)
(480) 853-0515
Entity
Organization
Contact information
Practice address
7530 TIDEWATER DR, NORFOLK, VA 23505-3717
(757) 480-3051
Mailing address
702 SW 8TH ST, BENTONVILLE, AR 72716-0445
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
3336C0003X
Community/Retail Pharmacy
Primary
0201004126
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
010385610
—
VA
05
—
1639234768
—
VA
01
—
2106158
PK
—
Enumeration date
12/27/2006
Last updated
06/16/2025
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