OrganizationWal-Mart Stores East Lp(<Unavail>)PharmacySuppliersPractice Address312 Palisades Blvd, Birmingham, AL 35209-5148(205) 870-7170PECOS EnrollmentBased on the most recent information from CMS, provider Wal-Mart Stores East Lp does not have current enrollment records in PECOS.Part BMedicare Part BNot EnrolledHHAHome Health AgencyNot EnrolledDMEDurable Medical EquipmentNot EnrolledPMDPower Mobility DeviceNot EnrolledCMS last updated its PECOS records 8 days ago.Profile DetailsProvider ID1477687317Provider TypeOrganizationFull NameWal-Mart Stores East LpOther Name<Unavail>SubpartNoEnumeration Date3/15/2007Last Updated8/6/2025Contact InformationPractice LocationPractice Address312 Palisades Blvd, Birmingham, AL 35209-5148Phone(205) 870-7170FaxUnlisted FaxMailing LocationMailing Address702 SW 8th St, Bentonville, AR 72716-0445PhoneUnlisted PhoneFaxUnlisted FaxAuthorized OfficialNameCanonic, Kimberly (Senior Director, Enrollment)Phone(480) 277-6348Provider TaxonomiesCodeDescriptionLicenseCode3336C0003XPrimaryDescriptionPharmacySuppliersLicense112935AlabamaCode332B00000XDescriptionDurable Medical Equipment & Medical SuppliesSuppliersLicenseUnlisted IssuerProvider IdentifiersIDDescriptionIssuerID100039124DescriptionMedicaidIssuerUnlistedAlabamaID1996006DescriptionOtherIssuerPK