Organization
WAL-MART STORES EAST LP
Active
Other names
Walmart Pharmacy 10-7179
Organization subpart
No
Provider details
NPI number
Authorized official
KIMBERLY CANONIC (SENIOR DIRECTOR, ENROLLMENT)
(480) 853-0515
Entity
Organization
Contact information
Practice address
1109 W CORBETT AVE, SWANSBORO, NC 28584-8461
(910) 708-5012
(910) 708-5023
Mailing address
702 SW 8TH ST, BENTONVILLE, AR 72716-0445
(479) 277-2500
(479) 277-4331
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
333600000X
Pharmacy
Primary
13411
NC
3336C0003X
Community/Retail Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2172769
PK
—
Enumeration date
09/26/2017
Last updated
06/11/2025
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