NPI age
19 years
Enumerated 2006-07-16
● Active Type 2 · Organization
Wal-Mart Stores East Lp
Wal-Mart Stores East Lp is 1 of 1965 pharmacy organizations in Georgia.
Primary specialty
Pharmacy
Plus 2 secondary
Practice locations
1
0 secondary on file
Status
Active
No deactivations on record
Authorized official
Canonic
Senior Director, Enrollment
Last NPPES update
2025-06-19
Source: monthly bulk 2026-05
How this organization compares
Across 1965 active pharmacy providers in Georgia.
NPI age
19 years
≈ at median (19 yr)
Practice locations
1
0 secondary on file
Subspecialties
2
In the 65% of peers with subspecialties
NPI lifetime · 2006 → 2026
2006-07Enumerated in NPPES
2006
2026
Where they practice
Primary practice location
3615 Marietta Hwy
Dallas, GA 301579472
Mailing address
702 Sw 8th St
Bentonville, AR 727160445
Authorized official
Kimberly Canonic
Senior Director, Enrollment
📞 4808530515
Individual providers at this organization
1 individual provider on file at this primary practice address.
- Charisse Braxton, FNP Nurse Practitioner NPI 1285678482
Specialties
-
Pharmacy PrimaryA pharmacy where pharmacists store, prepare, and dispense medicinal preparations and/or prescriptions for a local patient population in accordance with federal and state law; counsel patients and caregivers (sometimes independent of the...
-
Durable Medical Equipment & Medical SuppliesA supplier of medical equipment such as respirators, wheelchairs, home dialysis systems, or monitoring systems, that are prescribed by a physician for a patient's use in the home and that are usable for an extended period of time.
-
PharmacyA facility used by pharmacists for the compounding and dispensing of medicinal preparations and other associated professional and administrative services. A pharmacy is a facility whose primary function is to store, prepare and legally...
Identifiers
| Type | Value | Notes |
|---|---|---|
| 05 (GA) | PHRE009000 | |
| 05 (GA) | 000940541Q | |
| 05 (GA) | 00940541Q | |
| 01 | 2016149 | PK |
Other names on file (2)
Doing-business-as, former, and alternate names recorded by NPPES.
-
WAL-MART PHARMACY 10-3403
-
WAL-MART PHARMACY 10-3403
Practice context
Multi-provider organization. 1 individual provider on file at this primary address.
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- Confirm the NPI on NPPES.The CMS registry is the system of record. Open NPPES →
- Verify the organization is in good standing.Cross-check with the state's business registration and any applicable licensing boards.
- Confirm payer enrollment if billing.NPI presence does not guarantee active enrollment with Medicare, Medicaid, or commercial payers.