Healthcare Provider Details

I. General information

NPI: 1639098874
Provider Name (Legal Business Name): WAL-MARE STORES EAST LP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/13/2026
Last Update Date: 07/13/2026
Certification Date: 06/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9700 OCEAN HIGHWAY WEST
CALABASH NC
28467
US

IV. Provider business mailing address

1 CUSTOMER DR
BENTONVILLE AR
72716-0445
US

V. Phone/Fax

Practice location:
  • Phone: 910-393-4060
  • Fax: 910-393-4046
Mailing address:
  • Phone: 405-202-9925
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: KIMBERLY CANONIC
Title or Position: DIRECTOR OF HEALTH CARE CONTRACT
Credential:
Phone: 480-277-6348