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Wal-Mart Stores East Lp

Community/Retail Pharmacy in Stone Mountain, GA · enumerated 2013 · authorized official Kimberly Canonic, Senior Director, Enrollment.

Data current as of Jul 13, 2026 · sourced from CMS NPPES

National Provider Identifier

1053755314

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Registry record

Entity type Organization (Type 2)
Legal business name Wal-Mart Stores East Lp
Other name <Unavail>
Practice address 5935 Memorial Dr, Stone Mountain, GA, 30083
Phone (404) 260-6149
Fax (404) 260-6143
Enumeration date Apr 17, 2013
Last updated in NPPES Jun 5, 2025

Taxonomy & classification

332B00000X Durable Medical Equipment & Medical Supplies Suppliers Secondary
3336C0003X Community/Retail Pharmacy Suppliers · License PHRE009923 (GA) Primary

Authorized official

Name Kimberly Canonic
Title Senior Director, Enrollment
Phone (480) 277-6348

Other identifiers

Identifier Type State Issuer
003139820A Medicaid GA -
2140077 Other - PK

What is an NPI number?

A National Provider Identifier (NPI) is a unique 10-digit number that CMS assigns to every U.S. healthcare provider and organization under HIPAA. Type 1 NPIs identify individual providers; Type 2 NPIs identify organizations. The NPI appears on insurance claims, prescriptions, and credentialing paperwork, and never changes, even if the provider moves or changes specialty.

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Frequently asked questions

Where is Wal-Mart Stores East Lp located?
The practice location on file with NPPES is in Stone Mountain, GA.
How current is this record?
Data comes from the CMS NPPES public dissemination file; this record was last updated in NPPES on 2025-06-05. Verify at npiregistry.cms.hhs.gov.

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Source: CMS NPPES (public data). Snapshot 2026-07-13. Provider record last updated 2025-06-05.