Wal-Mart Stores East LP
Pharmacy, Community/Retail Pharmacy in Hazlehurst, GA. Organization (NPI-2).
NPI number1104843515
StatusActive
Last updated in NPPESJun 4, 2025
Details
- NPI
- 1104843515
- Entity type
- Organization (NPI-2)
- Legal business name
- Wal-Mart Stores East LP
- Organization subpart
- No
- Enumeration date
- Jul 16, 2006
- Certification date
- Jun 4, 2025
- Last updated
- Jun 4, 2025
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 3336C0003X | Pharmacy, Community/Retail Pharmacy | PHRE006807 | GA | Yes |
| 332B00000X | Durable Medical Equipment & Medical Supplies | – | – | |
| 333600000X | Pharmacy | – | – |
Other names
- Walmart Pharmacy 10-1061 (Doing Business As)
Practice location
136 E Jarman StHazlehurst, GA 31539-6130
Phone 912-375-3646
Mailing address
702 Sw 8th StBentonville, AR 72716-0445
Authorized official
Kimberly Canonic
Senior Director, Enrollment
4802776348
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All 6 Community/Retail Pharmacy providers in Hazlehurst · All 157 providers in Hazlehurst
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