Organization
WAL-MART STORES EAST LP
Active
Other names
Wal-Mart Pharmacy 10-3795
Organization subpart
No
Provider details
NPI number
Authorized official
KIMBERLY CANONIC (SENIOR DIRECTOR, ENROLLMENT)
(480) 277-6348
Entity
Organization
Contact information
Practice address
2100 88TH ST, NORTH BERGEN, NJ 07047-4709
(201) 758-2891
Mailing address
702 SW 8TH ST, BENTONVILLE, AR 72716-0445
(479) 277-1242
(479) 277-4331
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
3336C0003X
Community/Retail Pharmacy
Primary
28RS00699800
NJ
3336S0011X
Specialty Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0223476
—
NJ
01
—
2122817
PK
—
Enumeration date
11/13/2009
Last updated
07/08/2025
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