Organization
WAL-MART STORES EAST LP
Active
Other names
Wal-Mart Pharmacy 10-5922
Organization subpart
No
Provider details
NPI number
Authorized official
KIMBERLY CANONIC (SENIOR DIRECTOR, ENROLLMENT)
(480) 277-6348
Entity
Organization
Contact information
Practice address
546 FIRST COLONIAL RD, VIRGINIA BEACH, VA 23451-6120
(757) 364-7614
(757) 364-7613
Mailing address
702 SW 8TH ST, MAIL STOP 0445, BENTONVILLE, AR 72716-0445
(479) 277-1242
(479) 277-4331
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
333600000X
Pharmacy
Primary
—
—
3336C0003X
Community/Retail Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2167511
PK
—
Enumeration date
10/31/2016
Last updated
06/10/2025
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