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Wal-Mart Stores East Lp

Community/Retail Pharmacy in Versailles, MO · enumerated 2007 · authorized official Kimberly Canonic, Senior Director, Enrollment.

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

National Provider Identifier

1861542110

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Registry record

Entity type Organization (Type 2)
Legal business name Wal-Mart Stores East Lp
Other name <Unavail>
Practice address 1003 W Newton St, Versailles, MO, 65084
Phone (573) 378-5421
Enumeration date Jan 11, 2007
Last updated in NPPES May 30, 2025

Taxonomy & classification

332B00000X Durable Medical Equipment & Medical Supplies Suppliers Secondary
333600000X Pharmacy Suppliers Secondary
3336C0003X Community/Retail Pharmacy Suppliers · License 2002009217 (MO) Primary

Authorized official

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

Other identifiers

Identifier Type State Issuer
602242000 Medicaid MO -
2050753 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 Versailles, MO.
How current is this record?
Data comes from the CMS NPPES public dissemination file; this record was last updated in NPPES on 2025-05-30. Verify at npiregistry.cms.hhs.gov.

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Source: CMS NPPES (public data). Snapshot 2026-07-13. Provider record last updated 2025-05-30.