Wal-Mart Stores East Lp
Wal-Mart Stores East Lp is a healthcare organization registered as Community/Retail Pharmacy in Picayune, MS, holding Type 2 (organization) NPI 1720005135 since 2006. The authorized official on file is Kimberly Canonic, Senior Director, Enrollment.
✓ Active NPI ✓ Valid NPI checksum
| NPI | 1720005135 |
|---|---|
| Entity type | Organization (Type 2) |
| Legal business name | Wal-Mart Stores East Lp |
| Other name | <Unavail> |
| Practice address | 235 FRONTAGE RD, Picayune, MS, 39466 |
| Phone | 6017991063 |
| Enumeration date | 2006-07-16 |
| Last updated in NPPES | 2025-06-04 |
Authorized official
| Name | Kimberly Canonic |
|---|---|
| Title | Senior Director, Enrollment |
| Phone | 4802776348 |
Taxonomy & classification
| Taxonomy code | Specialty | Primary | License | State |
|---|---|---|---|---|
| 332B00000X | Durable Medical Equipment & Medical Supplies | Secondary | — | — |
| 333600000X | Pharmacy | Secondary | — | — |
| 3336C0003X | Community/Retail Pharmacy | Primary | 01964 | MS |
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 2044977 | Other | — | PK |
| 30591 | Medicaid | MS | — |
| 01834315 | Medicaid | MS | — |
Copy-ready billing details
Provider: Wal-Mart Stores East Lp NPI: 1720005135 Taxonomy: 3336C0003X (Community/Retail Pharmacy) Address: 235 FRONTAGE RD, Picayune, MS, 39466
Providers at this address
| NPI | Name | Type | Specialty | Location |
|---|---|---|---|---|
| 1316020449 | Wal-Mart Stores East, Lp | Organization | Eyewear Supplier | Picayune, MS |
| 1639258411 | Johneen Gilich | Individual | Optometrist | Picayune, MS |
| 1144622895 | Nicole Cousin | Individual | Pharmacist | Picayune, MS |
| 1669875100 | Tammy Mccray | Individual | Pharmacist | Picayune, MS |
| 1053293092 | Jacelyn Roussell | Individual | Pharmacist | Picayune, MS |
Verify this record
Cross-check NPI 1720005135 against the authoritative CMS record: view Wal-Mart Stores East Lp on the official NPPES registry .
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. Read the full guide or validate an NPI number.
Frequently asked questions
Who is the authorized official for Wal-Mart Stores East Lp?
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Source: CMS NPPES (public data). Snapshot 2026-07-11. Provider record last updated 2025-06-04.