Organization
WAL-MART STORES EAST LP
Active
Other names
Walmart Pharmacy 10-3212
Organization subpart
No
Provider details
NPI number
Authorized official
KIMBERLY CANONIC (SENIOR DIRECTOR, ENROLLMENT)
(480) 853-0515
Entity
Organization
Contact information
Practice address
6801 BLACK HORSE PIKE STE 100, STE 100, EGG HARBOR TOWNSHIP, NJ 08234-4131
(609) 415-6352
(609) 415-6351
Mailing address
702 SW 8TH ST, MS 0445, BENTONVILLE, AR 72716-0445
(479) 277-1242
(479) 277-4331
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
333600000X
Pharmacy
Primary
28RS00757200
NJ
3336C0003X
Community/Retail Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0597961
—
NJ
01
—
2169018
PK
—
Enumeration date
03/02/2017
Last updated
06/12/2025
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