Wal-Mart Stores East LP
Pharmacy, Community/Retail Pharmacy in Lilburn, GA. Organization (NPI-2).
NPI number1104843424
StatusActive
Last updated in NPPESJul 11, 2025
Details
- NPI
- 1104843424
- Entity type
- Organization (NPI-2)
- Legal business name
- Wal-Mart Stores East LP
- Organization subpart
- No
- Enumeration date
- Jul 16, 2006
- Certification date
- Jul 11, 2025
- Last updated
- Jul 11, 2025
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 3336C0003X | Pharmacy, Community/Retail Pharmacy | PHRE007153 | GA | Yes |
| 332B00000X | Durable Medical Equipment & Medical Supplies | – | – | |
| 333600000X | Pharmacy | – | – |
Other names
- Wal-Mart Pharmacy 10-1373 (Doing Business As)
Practice location
4004 Lawrenceville Hwy NwLilburn, GA 30047-2820
Phone 770-921-0228
Mailing address
702 Sw 8th StMail Stop 0445
Bentonville, AR 72716-0445
Phone 479-277-1242
Authorized official
Kimberly Canonic
Senior Director, Enrollment
4802776348
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