Organization
WAL-MART STORES EAST LP
Active
Other names
WalMart Pharmacy 10-5735
Organization subpart
No
Provider details
NPI number
Authorized official
KIMBERLY CANONIC (SENIOR DIRECTOR, ENROLLMENT)
(480) 853-0515
Entity
Organization
Contact information
Practice address
5010 STEINER WAY, GROVETOWN, GA 30813-5010
(706) 860-8808
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
PHRE009602
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2121924
PK
—
05
—
822181014A
—
GA
Enumeration date
08/25/2009
Last updated
07/07/2025
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