Organization · Type 2 NPI

Wal-Mart Stores East LP

Community/Retail Pharmacy · Jefferson City, MO

NPI number 1205079100 Active

Practice location

401 Supercenter Dr
Jefferson City, MO 65101-8190

Call (573) 635-3877 Map

Mailing address

702 SW 8th St
Bentonville, AR 72716-0445

Specialties and licenses

Taxonomy	Code	License
Durable Medical Equipment & Medical Supplies	332B00000X	None listed
Community/Retail Pharmacy Primary	3336C0003X	2009013741 (MO)

Community/Retail Pharmacy: 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 dispensing process); administer vaccinations; and provide other professional services associated with pharmaceutical care such as health screenings, consultative services with other …

11 other providers at this address

Other community/retail pharmacy providers in Jefferson City

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NPI record

NPI: 1205079100
Entity type: Organization (Type 2)
Issued: Apr 8, 2009
Last updated: Jun 13, 2025
Status: Active

Other names

<unavail>
Walmart Pharmacy 10-5477 · doing business as
Walmart Pharmacy 10-5477 · doing business as

Authorized official

Kimberly Canonic
Senior Director, Enrollment
(480) 853-0515

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This page mirrors the public NPPES file. For credentialing or billing, confirm it on the official CMS NPI Registry, and check the license with the state board.

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About NPI 1205079100

Wal-Mart Stores East LP's National Provider Identifier is 1205079100, issued on Apr 8, 2009. The primary taxonomy on file is Community/Retail Pharmacy (3336C0003X), and the practice location is in Jefferson City, MO. The record was last updated on Jun 13, 2025.