Organization
WAL-MART STORES EAST LP
Active
Other names
Walmart Pharmacy 10-5740
Organization subpart
No
Provider details
NPI number
Authorized official
KIMBERLY CANONIC (SENIOR DIRECTOR, ENROLLMENT)
(480) 853-0515
Entity
Organization
Contact information
Practice address
2570 GOVERNMENT BLVD, MOBILE, AL 36606-1614
(251) 586-6486
(251) 586-6482
Mailing address
702 SW 8TH ST, MAILSTOP 0445, BENTONVILLE, AR 72716-0445
(479) 204-8550
(479) 277-4331
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
3336C0003X
Community/Retail Pharmacy
Primary
114541
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1730558123
—
AL
01
—
2154298
PK
—
Enumeration date
09/16/2015
Last updated
07/08/2025
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