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Contact Information

WAL-MART STORES EAST LP
369 SCOTTS FORK-BONNIE RD
SUTTON, WV26601
 Phone: 304-689-3006
 Fax:
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Community/Retail Pharmacy

3336C0003X 58 Medical Supply Company with Pharmacist
 

Durable Medical Equipment & Medical Supplies

332B00000X 54 Other Medical Supply Company
Indicates primary specialty

NPI Profile & details for WAL-MART STORES EAST LP

NPI # 1912391772
LBN Legal business name WAL-MART STORES EAST LP
Authorized official KIMBERLY CANONIC - (SENIOR DIRECTOR, ENROLLMENT)
Entity Organization
Organization subpart 1 No
Enumeration date 03/19/2015
Last updated 06/10/2025 - About 12 months ago
Identifiers
WV License # MP0552414
WV Medicaid 3910006994
Other 2150883 PK
1 Some organization health care providers are made up of components that furnish different types of health care or have separate physical locations where health care is furnished. These components and physical locations are not themselves legal entities, but are part of the organization health care provider (which is a legal entity). A covered organization provider may decide that its subparts (if it has any) should have their own NPI numbers. If a subpart conducts any HIPAA standard transactions on its own (e.g., separately from its parent), it must obtain its own NPI number.

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