Wal-Mart Stores East LP

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

01964 Issued in MS

Legal business name

WAL-MART STORES EAST LP

Practice address

235 Frontage Rd
Picayune, MS 39466-7587

Phone

(601) 799-1063

NPI assigned

Jul 16, 2006

Organization subpart

No

Name

Kimberly Canonic

Title

Senior Director, Enrollment

Phone

(480) 277-6348

Organizations this organization is a member of, according to the National Provider Directory.

• Sams East Inc

  • Community/Retail Pharmacy
  • Hudson, NH
  • NPI 1982621009

  Member Of

  NPD member
• Walmart Inc.

  • Community/Retail Pharmacy
  • Pearl City, HI
  • NPI 1174541650

  Member Of

  NPD member

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Medicare fee-for-service enrollment

Enrolled in MS2 enrollments

Enrollment records 2

Tax ID family

Ability Network4,651 organizations share this tax ID, including this one

Organizations with this tax ID in the same state 24

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

• Wal-Mart Stores East LP

  • Pharmacy
  • Ocean Springs, MS
  • NPI 1629526694
  NPD tax ID
• Wal-Mart Stores East LP

  • Community/Retail Pharmacy
  • Meridian, MS
  • NPI 1639196041
  NPD tax ID
• Wal-Mart Stores East LP

  • Community/Retail Pharmacy
  • Olive Branch, MS
  • NPI 1639197163
  NPD tax ID
• Wal-Mart Stores East LP

  • Community/Retail Pharmacy
  • Gulfport, MS
  • NPI 1679590103
  NPD tax ID
• Wal-Mart Stores East LP

  • Pharmacy
  • Meridian, MS
  • NPI 1700323599
  NPD tax ID
• Wal-Mart Stores East LP

  • Community/Retail Pharmacy
  • Indianola, MS
  • NPI 1700803111
  NPD tax ID
• Wal-Mart Stores East LP

  • Community/Retail Pharmacy
  • Flowood, MS
  • NPI 1700803129
  NPD tax ID
• Wal-Mart Stores East LP

  • Community/Retail Pharmacy
  • Canton, MS
  • NPI 1710314687
  NPD tax ID
• Wal-Mart Stores East LP

  • Community/Retail Pharmacy
  • Biloxi, MS
  • NPI 1710904123
  NPD tax ID
• Wal-Mart Stores East LP

  • Community/Retail Pharmacy
  • Kosciusko, MS
  • NPI 1720006257
  NPD tax ID
• Wal-Mart Stores East LP

  • Community/Retail Pharmacy
  • Gulfport, MS
  • NPI 1730559832
  NPD tax ID
• Wal-Mart Stores East LP

  • Community/Retail Pharmacy
  • Hernando, MS
  • NPI 1790702116
  NPD tax ID

• WALMART PHARMACY 10-0970 Doing business as

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Jun 4, 2025.

{
    "created_epoch": "1153008000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1748995200000",
    "number": "1720005135",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "702 SW 8TH ST",
            "city": "BENTONVILLE",
            "state": "AR",
            "postal_code": "727160445",
            "telephone_number": "479-277-1242"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "235 FRONTAGE RD",
            "city": "PICAYUNE",
            "state": "MS",
            "postal_code": "394667587",
            "telephone_number": "601-799-1063"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WAL-MART STORES EAST LP",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-16",
        "last_updated": "2025-06-04",
        "certification_date": "2025-06-04",
        "status": "A",
        "authorized_official_last_name": "CANONIC",
        "authorized_official_first_name": "KIMBERLY",
        "authorized_official_title_or_position": "SENIOR DIRECTOR, ENROLLMENT",
        "authorized_official_telephone_number": "480-277-6348"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "MS",
            "license": "01964",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2044977",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "30591",
            "state": "MS"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "01834315",
            "state": "MS"
        }
    ],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "https://esmd.abilitynetwork.com:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRRequest_Service",
            "affiliation": "Y",
            "endpointDescription": "2.16.840.1.113883.3.667.2",
            "affiliationName": "Ability Network",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "CMS esMD eMDR",
            "address_1": "100 N 6th St Ste 900A",
            "city": "Minneapolis",
            "state": "MN",
            "country_code": "US",
            "postal_code": "554031516",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "WALMART PHARMACY 10-0970",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Rose Vicknair
• Roxanne Vincent, P.C.A
• Rhonda A Vinet
• Stacey S Vollenweider, OTR/L
• Rosary Bahman Voorhies, LOTR
• Wal-Mart Stores East, LP
• Walgreen Co
• Walgreen Co
• Walgreen Co
• Catherine Waller, LCSW

• All providers in Picayune, MS
• Community/Retail Pharmacy in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 4, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.