Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Wal-Mart Stores East LP

Organization Durable Medical Equipment & Medical Supplies · NPI 1760409940

Wal-Mart Stores East LP is a Durable Medical Equipment & Medical Supplies in Jefferson City, Tennessee. Licensed in Tennessee. Registered with an NPI since 2006.

Licensed in
TN
In the registry since
2006
Specialties on file
3
What do these letters mean?
LP — Limited partnership
A form of business registration, not a clinical qualification.

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Practice location Address checks out

630 E Broadway Blvd
Jefferson City, TN 37760-4900
Phone: (865) 475-3736
Fax: (865) 475-3954
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Community/Retail Pharmacy (primary) Taxonomy 3336C0003X · Licence C2243 (TN)
Durable Medical Equipment & Medical Supplies Taxonomy 332B00000X
Pharmacy Taxonomy 333600000X

Record details

NPI number1760409940
Entity typeOrganization (Type 2)
Organization subpartNo
Authorized official Kimberly Canonic — Senior Director, Enrollment · (480) 277-6348
Other names Wal-Mart Pharmacy 10-0724
NPI enumeratedJuly 16, 2006
Last updated in NPPESJune 3, 2025
Certification dateJune 3, 2025
Mailing address702 Sw 8th St, Bentonville, AR 72716-0445

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