Organization
WAL-MART STORES EAST, LP
Active
Other names
Walmart Pharmacy 10-6233
Organization subpart
No
Provider details
NPI number
Authorized official
KIMBERLY CANONIC (SENIOR DIRECTOR, ENROLLMENT)
(480) 277-6348
Entity
Organization
Contact information
Practice address
11560 N TRYON ST, CHARLOTTE, NC 28262-0000
(980) 428-8133
(980) 428-8132
Mailing address
702 SW 8TH ST, MS 0445, BENTONVILLE, AR 72716-0445
(479) 204-8550
(479) 204-8550
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
333600000X
Pharmacy
Primary
13058
NC
3336C0003X
Community/Retail Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1689122905
—
NC
01
—
2163692
PK
—
Enumeration date
09/15/2016
Last updated
06/09/2025
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