Organization
WAL-MART STORES EAST LP
Active
Other names
WAL-MART PHARMACY 10-3852
Organization subpart
No
Provider details
NPI number
Authorized official
KIMBERLY CANONIC (SENIOR DIRECTOR ENROLMENT)
(480) 853-0515
Entity
Organization
Contact information
Practice address
110 ROCKY BOTTOM DR, UNICOI, TN 37692-4030
(423) 743-9998
(423) 743-8087
Mailing address
702 SW 8TH ST, BENTONVILLE, AR 72716-0445
(479) 204-8550
(479) 277-4331
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
3336C0003X
Community/Retail Pharmacy
Primary
4278
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2095012
PK
—
05
—
466406
—
TN
Enumeration date
06/12/2006
Last updated
07/08/2025
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