Organization
WAL-MART STORES EAST LP
Active
Other names
WAL-MART PHARMACY 10-3611
Organization subpart
No
Provider details
NPI number
Authorized official
KIMBERLY CANONIC (SENIOR DIRECTOR, ENROLLMENT)
(480) 277-6348
Entity
Organization
Contact information
Practice address
6520 ERNEST BARRETT PKWY, MARIETTA, GA 30064-4571
(770) 222-6695
Mailing address
702 SW 8TH ST, BENTONVILLE, AR 72716-0445
(479) 277-1242
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
3336C0003X
Community/Retail Pharmacy
Primary
PHRE009089
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2016386
PK
—
05
—
425255531A
—
GA
Enumeration date
10/12/2006
Last updated
07/02/2025
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