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NPI Code Detail

MEDICARE: WAL-MART STORES EAST LP

MEDICARE: WAL-MART STORES EAST LP
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1332B00000XDurable Medical Equipment & Medical Supplies
23336C0003XCommunity/Retail Pharmacy0201004628VA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
12150121OTHERPK
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1619367174
Entity Type Code : Organization
Provider Name (Legal Business Name) : WAL-MART STORES EAST LP
Provider Business Mailing Address
First Line : 702 SW 8TH ST
Second Line :
City : BENTONVILLE
State : AR
Zip : 72716-6209
Country : US
Telephone Number : 479-277-2500
Fax Number : 479-277-4331
Provider Business Practice Location Address
First Line : 5700 HOPKINS RD
Second Line :
City : NORTH CHESTERFIELD
State : VA
Zip : 23234-6631
Country : US
Telephone Number : 804-253-0759
Fax Number : 804-253-9788
Authorized Official
Title or Position : SENIOR DIRECTOR, ENROLLMENT
Name : KIMBERLY CANONIC
Credential :
Telephone Number : 480-277-6348
Provider Enumeration Date : 02/04/2015
Last Update Date : 06/06/2025

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1679174395 — KIA MARIE DAVIS PHARMD
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Directions to “WAL-MART STORES EAST LP ” Practice Location

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