Organization
WAL-MART STORES EAST LP
Active
Other names
Walmart Pharmacy 10-6174
Organization subpart
No
Provider details
NPI number
Authorized official
KIMBERLY CANONIC (SENIOR DIRECTOR, ENROLLMENT)
(480) 277-6348
Entity
Organization
Contact information
Practice address
10635 DORCHESTER RD, SUMMERVILLE, SC 29485-7610
(843) 879-5150
(843) 879-5151
Mailing address
702 SW 8TH ST, MS 0445, BENTONVILLE, AR 72716-0445
(479) 277-2500
(479) 277-4331
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
3336C0003X
Community/Retail Pharmacy
Primary
16084
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2150892
PK
—
05
—
716084
—
SC
Enumeration date
03/19/2015
Last updated
06/09/2025
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