Organization
WAL-MART STORES EAST LP
Active
Other names
Walmart Pharmacy 10-5923
Organization subpart
No
Provider details
NPI number
Authorized official
KIMBERLY CANONIC (SENIOR DIRECTOR, ENROLLMENT)
(480) 277-6348
Entity
Organization
Contact information
Practice address
3650 WALTON DR, MYRTLE BEACH, SC 29577-6775
(843) 839-9875
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
Primary
16595
SC
3336C0003X
Community/Retail Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2159546
PK
—
05
—
716595
—
SC
Enumeration date
04/05/2016
Last updated
06/10/2025
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