Organization
WAL-MART STORES EAST LP
Active
Other names
Walmart Pharmacy 10-4148
Organization subpart
No
Provider details
NPI number
Authorized official
KIMBERLY CANONIC (SENIOR DIRECTOR, ENROLLMENT)
(480) 277-6348
Entity
Organization
Contact information
Practice address
8800 E W T HARRIS BLVD, CHARLOTTE, NC 28227-2402
(704) 916-1892
(704) 916-1892
Mailing address
1 CUSTOMER DR, MAILSTOP 0445, BENTONVILLE, AR 72716-0445
(480) 853-0515
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
3336C0003X
Community/Retail Pharmacy
Primary
11988
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1952711889
—
NC
01
—
2146457
PK
—
Enumeration date
04/30/2014
Last updated
03/30/2026
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