Organization
WAL-MART STORES EAST LP
Active
Other names
WAL-MART PHARMACY 10-3733
Organization subpart
No
Provider details
NPI number
Authorized official
KIMBERLY CANONIC (SENIOR DIRECTOR, ENROLLMENT)
(480) 853-0515
Entity
Organization
Contact information
Practice address
1151 STONECREST BLVD, TEGA CAY, SC 29708-6555
(803) 578-4140
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
9838
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2093483
PK
—
05
—
798385
—
SC
Enumeration date
01/16/2008
Last updated
07/08/2025
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