Organization
WAL-MART STORES EAST LP
Active
Other names
WalMart Pharmacy 10-4157
Organization subpart
No
Provider details
NPI number
Authorized official
KIMBERLY CANONIC (SENIOR DIRECTOR, ENROLLMENT)
(480) 277-6348
Entity
Organization
Contact information
Practice address
2750 NC 55 HWY, CARY, NC 27519-6205
(919) 335-0056
Mailing address
702 SW 8TH ST, BENTONVILLE, AR 72716-6209
(479) 277-1238
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
3336C0003X
Community/Retail Pharmacy
Primary
11342
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1841548021
—
NC
01
—
2136602
PK
—
Enumeration date
08/21/2012
Last updated
06/06/2025
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