Organization
WAL-MART STORES EAST LP
Active
Other names
Walmart Pharmacy 10-6370
Organization subpart
No
Provider details
NPI number
Authorized official
KIMBERLY CANONIC (SENIOR DIRECTOR, ENROLLMENT)
(480) 277-6348
Entity
Organization
Contact information
Practice address
4331 W ANDREW JOHNSON HWY, MORRISTOWN, TN 37814-1036
(423) 254-6672
(423) 254-6674
Mailing address
702 SW 8TH ST, BENTONVILLE, AR 72716-0445
(479) 204-1258
(479) 277-4331
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
0000005508
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2150356
PK
—
Enumeration date
02/12/2015
Last updated
06/06/2025
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