Organization
WAL-MART STORES EAST LP
Active
Other names
WAL-MART PHARMACY 10-5319
Organization subpart
No
Provider details
NPI number
Authorized official
KIMBERLY CANONIC (SENIOR DIRECTOR, ENROLLMENT)
(480) 853-0515
Entity
Organization
Contact information
Practice address
1881 ROBERT C BRYD DR, MACARTHUR, WV 25873
(304) 256-6496
Mailing address
702 SW 8TH ST, BENTONVILLE, AR 72716-0445
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
552321
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2111556
PK
—
05
—
3810002314
—
WV
Enumeration date
07/18/2006
Last updated
06/13/2025
About Stedi
Stedi is the only programmable healthcare clearinghouse. You can use Stedi's APIs to process eligibility checks, claims, remits, and more.
Contact us