Organization
WAL-MART STORES EAST LP
Active
Other names
Walmart Pharmacy 10-3899
Organization subpart
No
Provider details
NPI number
Authorized official
KIMBERLY CANONIC (SENIOR DIRECTOR, ENROLLMENT)
(480) 853-0515
Entity
Organization
Contact information
Practice address
215 SAINT JAMES AVE, GOOSE CREEK, SC 29445-2938
(843) 714-6289
Mailing address
702 SW 8TH ST, MAILSTOP 0445, BENTONVILLE, AR 72716-0445
(479) 277-2500
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
3336C0003X
Community/Retail Pharmacy
Primary
16017
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2151775
PK
—
05
—
716017
—
SC
Enumeration date
05/04/2015
Last updated
06/10/2025
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