Organization
WAL-MART STORES EAST LP
Active
Other names
WALMART PHARMACY 10-4273
Organization subpart
No
Provider details
NPI number
Authorized official
KIMBERLY CANONIC (SENIOR DIRECTOR, ENROLLMENT)
(480) 277-6348
Entity
Organization
Contact information
Practice address
1112 NEW POINTE BLVD, LELAND, NC 28451-4115
(910) 383-1302
Mailing address
702 SW 8TH ST, MAIL STOP 0445, BENTONVILLE, AR 72716-0445
(479) 277-1242
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
3336C0003X
Community/Retail Pharmacy
Primary
09470
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0105489
—
NC
05
—
105489
—
NC
01
—
2066149
PK
—
Enumeration date
03/15/2007
Last updated
07/09/2025
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