DataLabs
datalabs.health made in the usa
DataLabs Facebook Wall   Like   Follow DataLabs on Twitter   Tweet  
Contact us Sign in |  Documentation | 
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
2333600000XPharmacy
33336C0003XCommunity/Retail Pharmacy3960TN

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
22094081OTHERPK

General Provider Information

NPI Number : 1104843200
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 : 72716-0445
Country : US
Telephone Number : 479-277-1242
Fax Number : 479-277-4331
Provider Business Practice Location Address
First Line : 2300 TREASURY DR SE
Second Line :
City : CLEVELAND
State : TN
Zip : 37323-7185
Country : US
Telephone Number : 423-472-0656
Fax Number : 423-472-0557
Authorized Official
Title or Position : SENIOR DIRECTOR, ENROLLMENT
Name : KIMBERLY CANONIC
Credential :
Telephone Number : 480-853-0515
Provider Enumeration Date : 07/16/2006
Last Update Date : 06/13/2025

Similar Medicare Providers

1558441261 — WAL-MART STORES EAST, LP
Practice Location Address:
2300 TREASURY DR SE
CLEVELAND, TN
37323-7185
Practice Phone: 423-472-9660
Practice Fax:
1790829067 — MR. ROBERT IRWIN FULFORD R.PH.
Practice Location Address:
2300 TREASURY DR SE
CLEVELAND, TN
37323-7185
Practice Phone: 423-472-0656
Practice Fax: 423-472-0557
1154570505 — DR. PAUL MICHAEL FLANAGAN O.D.
Practice Location Address:
2300 TREASURY DR SE
CLEVELAND, TN
37323-7185
Practice Phone: 423-472-3484
Practice Fax:
1184125270 — ALPABEN PATEL
Practice Location Address:
2300 TREASURY DR SE
CLEVELAND, TN
37323-7185
Practice Phone: 423-472-0656
Practice Fax:
1790286979 — ROBERT HAYS PHARMD
Practice Location Address:
2300 TREASURY DR SE
CLEVELAND, TN
37323-7185
Practice Phone: 423-472-0656
Practice Fax:
1811486830 — ELIZABETH SEVIC
Practice Location Address:
2300 TREASURY DR SE
CLEVELAND, TN
37323-7185
Practice Phone: 423-472-0656
Practice Fax:

Directions to “WAL-MART STORES EAST LP ” Practice Location

Language Start Address Practice Location
These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.