NPI age
19 years
Enumerated 2006-12-27
● 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 1 secondary
Practice locations
1
0 secondary on file
Status
Active
No deactivations on record
Authorized official
Canonic
Senior Director, Enrollment
Last NPPES update
2025-07-02
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
1
In the 65% of peers with subspecialties
NPI lifetime · 2006 → 2026
2006-12Enumerated in NPPES
2006
2026
Where they practice
Primary practice location
1871 Chamblee Tucker Rd
Chamblee, GA 303412737
Mailing address
702 Sw 8th St
Bentonville, AR 727160445
Authorized official
Kimberly Canonic
Senior Director, Enrollment
📞 4808530515
Individual providers at this organization
3 individual providers on file at this primary practice address.
- Razin Momin Pharmacist NPI 1427658384
- Panteha Mortazavi, PHARMD Pharmacist NPI 1992306039
- Ala Walker Technician/Technologist NPI 1477338945
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.
Identifiers
| Type | Value | Notes |
|---|---|---|
| 01 | 2016460 | PK |
| 05 (GA) | 623765613A |
Other names on file (1)
Doing-business-as, former, and alternate names recorded by NPPES.
-
WAL-MART PHARMACY 10-3621
Practice context
Multi-provider organization. 3 individual providers 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.