Organization
WAL-MART STORES EAST LP
Active
Other names
WalMart Pharmacy 10-4456
Organization subpart
No
Provider details
NPI number
Authorized official
KIMBERLY CANONIC (SENIOR DIRECTOR, ENROLLMENT)
(480) 853-0515
Entity
Organization
Contact information
Practice address
1 COOPERTOWNE BLVD, SOMERDALE, NJ 08083-1433
(856) 545-9074
Mailing address
702 SW 8TH ST, BENTONVILLE, AR 72716-6209
(479) 277-1238
(479) 277-4331
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
3336C0003X
Community/Retail Pharmacy
Primary
28RS00708700
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2126720
PK
—
Enumeration date
09/10/2010
Last updated
07/10/2025
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