Organization
WAL-MART STORES EAST LP
Active
Other names
WalMart Pharmacy 10-5779
Organization subpart
No
Provider details
NPI number
Authorized official
KIMBERLY CANONIC (SENIOR DIRECTOR, ENROLLMENT)
(480) 853-0515
Entity
Organization
Contact information
Practice address
16375 MERCHANTS LN, KING GEORGE, VA 22485-5655
(540) 413-3144
Mailing address
702 SW 8TH ST, BENTONVILLE, AR 72716-6209
(479) 277-1238
(479) 277-4331
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
3336C0003X
Community/Retail Pharmacy
Primary
0201004413
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2130771
PK
—
Enumeration date
06/16/2011
Last updated
06/16/2025
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