Organization
WAL-MART STORES EAST, LP
Active
Other names
Walmart Pharmacy 10-7011
Organization subpart
No
Provider details
NPI number
Authorized official
KIMBERLY CANONIC (SENIOR DIRECTOR, ENROLLMENT)
(480) 277-6348
Entity
Organization
Contact information
Practice address
5938 JULIAN AIRPORT RD, LIBERTY, NC 27298-8038
(405) 202-9925
(479) 277-4331
Mailing address
702 SW 8TH ST, BENTONVILLE, AR 72716-0445
(405) 202-9925
(479) 277-4331
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
3336C0003X
Community/Retail Pharmacy
Primary
—
—
Other
Enumeration date
04/10/2025
Last updated
04/10/2025
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