Organization
WAL-MART STORES EAST LP
Active
Other names
Walmart Pharmacy 10-5747
Organization subpart
No
Provider details
NPI number
Authorized official
KIMBERLY CANONIC (SENIOR DIRECTOR, ENROLLMENT)
(480) 853-0515
Entity
Organization
Contact information
Practice address
1876 MAIN ST W, LOCUST, NC 28097-7700
(704) 781-0574
Mailing address
702 SW 8TH ST, BENTONVILLE, AR 72716-0445
(479) 277-1238
(479) 277-4331
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
3336C0003X
Community/Retail Pharmacy
Primary
10306
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0845447
—
NC
01
—
2120422
PK
—
Enumeration date
05/13/2009
Last updated
07/08/2025
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