P Praxis·MD
● Active Type 2 · Organization

Wal-Mart Stores East Lp

Pharmacy·Waycross, GA· NPI 1770965634 · Enumerated 2015 · 10 years on NPI
Wal-Mart Stores East Lp is 1 of 1965 pharmacy organizations in Georgia.
NPI age
10 years
Enumerated 2015-06-26
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
2025-06-10
Source: monthly bulk 2026-05

How this organization compares

Across 1965 active pharmacy providers in Georgia.

NPI age
10 years
↓ 9 yr below median
Practice locations
1
0 secondary on file
Subspecialties
1
In the 65% of peers with subspecialties

NPI lifetime · 2015 → 2026

2015-06Enumerated in NPPES
2015 2026

Where they practice

Primary practice location
1630 Plant Ave
Waycross, GA 315015247
📞 7622095008fax 7622095007
Mailing address
702 Sw 8th St, Mailstop 0445
Bentonville, AR 727160445
📞 4792048550fax 4792774331

Authorized official

Kimberly Canonic
Senior Director, Enrollment
📞 4802776348

Individual providers at this organization

3 individual providers on file at this primary practice address.

Specialties

  • Pharmacy Primary
    A 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...
    GA license #PHRE010190 taxonomy 3336C0003X
  • Durable Medical Equipment & Medical Supplies
    A 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.
    taxonomy 332B00000X

Identifiers

TypeValueNotes
01 2154000 PK
05 (GA) 003168754A

Other names on file (1)

Doing-business-as, former, and alternate names recorded by NPPES.

  • WalMart Pharmacy 10-4527
    Type code 3 recorded 2016-12-13

Practice context

Multi-provider organization. 3 individual providers on file at this primary address.

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How to verify this organization

  1. Confirm the NPI on NPPES.The CMS registry is the system of record. Open NPPES →
  2. Verify the organization is in good standing.Cross-check with the state's business registration and any applicable licensing boards.
  3. Confirm payer enrollment if billing.NPI presence does not guarantee active enrollment with Medicare, Medicaid, or commercial payers.

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