Organization
WALMART STORES EAST LP
Active
Other names
Walmart Pharmacy 10-5734
Organization subpart
No
Provider details
NPI number
Authorized official
KIMBERLY CANONIC (SENIOR DIRECTOR, ENROLLMENT)
(480) 277-6348
Entity
Organization
Contact information
Practice address
750 LYNN GARDEN DR, KINGSPORT, TN 37660-5608
(423) 408-6162
(423) 408-6161
Mailing address
702 SW 8TH ST, BENTONVILLE, AR 72716-0445
(423) 405-6162
(423) 405-6161
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
3336C0003X
Community/Retail Pharmacy
Primary
0000005681
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2153792
PK
—
Enumeration date
08/11/2015
Last updated
06/10/2025
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