Organization
WAL-MART STORES EAST LP
Active
Other names
WALMART PHARMACY 10-5447
Organization subpart
No
Provider details
NPI number
Authorized official
KIMBERLY CANONIC (SENIOR DIRECTOR, ENROLLMENT)
(480) 853-0515
Entity
Organization
Contact information
Practice address
150 HARRISON AVE, KEARNY, NJ 07032-5950
(201) 955-0162
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
28RS00661900
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0105597
—
NJ
01
—
2055939
PK
—
Enumeration date
06/12/2006
Last updated
06/13/2025
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