Organization
WAL-MART STORES EAST, LP
Active
Organization
WAL-MART STORES EAST, LP
Active
Other names
Walmart Pharmacy 10-3912
Organization subpart
No
Provider details
NPI number
Authorized official
KIMBERLY CANONIC (SENIOR DIRECTOR, ENROLLMENT)
(480) 853-0515
Entity
Organization
Contact information
Practice address
461 RT 10 SUITE A100, LEDGEWOOD, NJ 07852
(973) 252-7666
Mailing address
702 SW 8TH ST, BENTONVILLE, AR 72716-0445
(479) 277-2500
(479) 277-4331
Taxonomy
Speciality
Code
Description
License number
State
156FX1800X
Optician
—
—
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
332H00000X
Eyewear Supplier
—
—
3336C0003X
Community/Retail Pharmacy
Primary
—
—
Other
Enumeration date
07/24/2020
Last updated
06/11/2025
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