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
1	332B00000X	Durable Medical Equipment & Medical Supplies
2	3336C0003X	Community/Retail Pharmacy	PHRE009089	GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2016386	OTHER		PK
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1790874386
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	:

Provider Business Practice Location Address
First Line	:	6520 ERNEST BARRETT PKWY
Second Line	:
City	:	MARIETTA
State	:	GA
Zip	:	30064-4571
Country	:	US
Telephone Number	:	770-222-6695
Fax Number	:

Authorized Official
Title or Position	:	SENIOR DIRECTOR, ENROLLMENT
Name	:	KIMBERLY CANONIC
Credential	:
Telephone Number	:	480-277-6348

Provider Enumeration Date	:	10/12/2006
Last Update Date	:	07/02/2025

Similar Medicare Providers

1770436685 — HARMAN LLC
Practice Location Address:

6520 ERNEST BARRETT PKWY
MARIETTA, GA
30064-4571

Practice Phone: 770-222-6603
Practice Fax:

1861576951 — WAL-MART STORES EAST, LP
Practice Location Address:

6520 ERNEST W BARRETT PKWY SW
MARIETTA, GA
30064-4571

Practice Phone: 770-222-6603
Practice Fax:

1194132951 — DR. AARON MICHAEL RAHN O.D.
Practice Location Address:

6520 ERNEST BARRETT PKWY
MARIETTA, GA
30064-4571

Practice Phone: 770-222-6603
Practice Fax:

1588073050 — ENFOCUS EYECARE LLC
Practice Location Address:

6520 ERNEST W BARRETT PKWY SW
MARIETTA, GA
30064-4571

Practice Phone: 770-222-6603
Practice Fax:

1477100501 — JENNIFER CHRISTINE JOHNON PHARMD
Practice Location Address:

6520 ERNEST W BARRETT PKWY SW
MARIETTA, GA
30064-4571

Practice Phone: 770-222-6695
Practice Fax:

1790385045 — KAZEM HAGHIR EBRAHIMABADI RPH
Practice Location Address:

6520 ERNEST BARRETT PKWY
MARIETTA, GA
30064-4571

Practice Phone: 770-222-6695
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.