Organization
WAL-MART STORES EAST, LP
Active
Other names
Walmart Pharmacy 10-3908
Organization subpart
No
Provider details
NPI number
Authorized official
KIMBERLY CANONIC (DIRECTOR OF HEALTH CARE CONTRACTING)
(480) 853-0515
Entity
Organization
Contact information
Practice address
2254 NASHVILLE HWY, COLUMBIA, TN 38401-7234
(931) 777-2132
Mailing address
1 CUSTOMER DR, BENTONVILLE, AR 72716-0445
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
333600000X
Pharmacy
Primary
—
—
3336C0003X
Community/Retail Pharmacy
—
—
Other
Enumeration date
07/28/2026
Last updated
07/28/2026
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