Organization
WAL-MART STORES EAST LP
Active
Other names
WalMart Pharmacy 10-4484
Organization subpart
No
Provider details
NPI number
Authorized official
KIMBERLY CANONIC (SENIOR DIRECTOR, ENROLLMENT)
(480) 277-6348
Entity
Organization
Contact information
Practice address
8000 TOWN DR, RALEIGH, NC 27616-2828
(919) 431-9632
Mailing address
702 SW 8TH ST, BENTONVILLE, AR 72716-6209
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
3336C0003X
Community/Retail Pharmacy
Primary
10888
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0920616
—
NC
01
—
2127453
PK
—
Enumeration date
10/27/2010
Last updated
08/06/2025
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