Organization
WAL-MART STORES EAST LP
Active
Other names
WALMART PHARMACY 10-5487
Organization subpart
No
Provider details
NPI number
Authorized official
KIMBERLY CANONIC (SENIOR DIRECTOR, ENROLLMENT)
(480) 853-0515
Entity
Organization
Contact information
Practice address
9 BENTON RD, TRAVELERS REST, SC 29690-2168
(864) 834-9224
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
8615
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2092975
PK
—
05
—
50008615
—
SC
05
—
786150
—
SC
Enumeration date
07/16/2006
Last updated
06/16/2025
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