Organization
WAL-MART STORES EAST LP
Active
Other names
Walmart Pharmacy 10-7238
Organization subpart
No
Provider details
NPI number
Authorized official
KIMBERLY CANONIC (SENIOR DIRECTOR, ENROLLMENT)
(480) 277-6348
Entity
Organization
Contact information
Practice address
11233B NC 55 HWY E, GRANTSBORO, NC 28529-9471
(252) 201-9012
Mailing address
702 SW 8TH ST, BENTONVILLE, AR 72716-0445
(479) 277-2500
(479) 277-4331
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
3336C0003X
Community/Retail Pharmacy
Primary
11989
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1972920577
—
NC
01
—
2145546
PK
—
Enumeration date
03/21/2014
Last updated
06/09/2025
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