Wal-Mart Stores East LP
Pharmacy, Community/Retail Pharmacy in Johnson City, TN. Organization (NPI-2).
NPI number1477570646
StatusActive
Last updated in NPPESJun 5, 2025
Details
- NPI
- 1477570646
- Entity type
- Organization (NPI-2)
- Legal business name
- Wal-Mart Stores East LP
- Organization subpart
- No
- Enumeration date
- Jul 16, 2006
- Certification date
- Jun 5, 2025
- Last updated
- Jun 5, 2025
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 3336C0003X | Pharmacy, Community/Retail Pharmacy | C1812 | TN | Yes |
| 332B00000X | Durable Medical Equipment & Medical Supplies | – | – | |
| 333600000X | Pharmacy | – | – |
Other names
- Wal-Mart Pharmacy 10-1080 (Doing Business As)
Practice location
3111 Browns Mill RdJohnson City, TN 37604-1418
Phone 423-282-9484 · Fax 423-282-0373
Mailing address
702 Sw 8th StBentonville, AR 72716-0445
Phone 479-204-8550 · Fax 479-277-4331
Authorized official
Kimberly Canonic
Senior Director, Enrollment
4802776348
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All 31 Community/Retail Pharmacy providers in Johnson City · All 4,629 providers in Johnson City
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