Organization
WAL-MART STORES EAST LP
Active
Other names
WAL-MART PHARMACY 10-2036
Organization subpart
No
Provider details
NPI number
Authorized official
KIMBERLY CANONIC (SENIOR DIRECTOR, ENROLLMENT)
(480) 277-6348
Entity
Organization
Contact information
Practice address
2700 MOUNTAINEER BLVD, SOUTH CHARLESTON, WV 25309-9442
(304) 746-1725
Mailing address
702 SW 8TH ST, BENTONVILLE, AR 72716-0445
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
MP0551158
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0227799018
—
WV
01
—
2110766
PK
—
05
—
227799018
—
WV
Enumeration date
07/16/2006
Last updated
06/05/2025
Update your record
If you believe information in your NPPES record is inaccurate, or if you wish to update or deactivate your NPI, you can do so directly with CMS at https://nppes.cms.hhs.gov.
About Stedi
Stedi is the only programmable healthcare clearinghouse. You can use Stedi's APIs to process eligibility checks, claims, remits, and more.
Sign up