Organization
WAL-MART STORES EAST LP
Active
Other names
WAL-MART PHARMACY 10-3337
Organization subpart
No
Provider details
NPI number
Authorized official
KIMBERLY CANONIC (SENIOR DIRECTOR, ENROLLMENT)
(480) 853-0515
Entity
Organization
Contact information
Practice address
3159 ROUTE 9 S, RIO GRANDE, NJ 08242-1012
(609) 465-4497
Mailing address
702 SW 8TH ST, BENTONVILLE, AR 72716-0445
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
3336C0003X
Community/Retail Pharmacy
Primary
28RS00670300
NJ
Other
Enumeration date
05/18/2007
Last updated
06/19/2025
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