Organization
WAL-MART STORES EAST LP
Active
Other names
WAL-MART PHARMACY 10-1688
Organization subpart
No
Provider details
NPI number
Authorized official
KIMBERLY CANONIC (SENIOR DIRECTOR, ENROLLMENT)
(480) 853-0515
Entity
Organization
Contact information
Practice address
657 PHOENIX DR, VIRGINIA BEACH, VA 23452-7318
(757) 498-3720
Mailing address
702 SW 8TH ST, BENTONVILLE, AR 72716-0445
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
0201002947
VA
3336S0011X
Specialty Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
008542252
—
VA
05
—
0497461
—
VA
01
—
2105757
PK
—
05
—
8542252
—
VA
Enumeration date
07/16/2006
Last updated
07/07/2025
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