Organization
WAL-MART STORES EAST LP
Active
Other names
Walmart Pharmacy 10-6887
Organization subpart
No
Provider details
NPI number
Authorized official
KIMBERLY CANONIC (SENIOR DIRECTOR, ENROLLMENT)
(480) 277-6348
Entity
Organization
Contact information
Practice address
300 BYPASS 25 NE, GREENWOOD, SC 29646-3009
(864) 321-6029
(864) 321-6036
Mailing address
702 SW 8TH ST, BENTONVILLE, AR 72716-6209
(479) 277-2500
(479) 277-4331
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
3336C0003X
Community/Retail Pharmacy
Primary
15998
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2151825
PK
—
05
—
715998
—
SC
Enumeration date
05/04/2015
Last updated
06/09/2025
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