Organization
WAL-MART STORES EAST LP
Active
Other names
WalMart Pharmacy 10-4258
Organization subpart
No
Provider details
NPI number
Authorized official
KIMBERLY CANONIC (SENIOR DIRECTOR, ENROLLMENT)
(480) 277-6348
Entity
Organization
Contact information
Practice address
11 VILLAGE PKWY, FREDERICKSBURG, VA 22406-8207
(540) 752-2618
Mailing address
702 SW 8TH ST, BENTONVILLE, AR 72716-6209
(479) 277-1242
(479) 277-4331
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
3336C0003X
Community/Retail Pharmacy
Primary
0201004308
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1841423969
—
VA
01
—
2121917
PK
—
Enumeration date
08/25/2009
Last updated
07/09/2025
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