Organization
WAL-MART STORES EAST LP
Active
Other names
WalMart Pharmacy 10-5797
Organization subpart
No
Provider details
NPI number
Authorized official
KIMBERLY CANONIC (SENIOR DIRECTOR, ENROLLMENT)
(480) 853-0515
Entity
Organization
Contact information
Practice address
262 CORDELE RD, ALBANY, GA 31705-2407
(229) 352-9459
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
—
—
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
PHRE009750
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000940541R
—
GA
01
—
2129918
PK
—
Enumeration date
04/11/2011
Last updated
06/16/2025
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