Organization
WAL-MART STORES EAST LP
Active
Other names
WalMart Pharmacy 10-5752
Organization subpart
No
Provider details
NPI number
Authorized official
KIMBERLY CANONIC (SENIOR DIRECTOR, ENROLLMENT)
(480) 853-0515
Entity
Organization
Contact information
Practice address
174 PASSAIC ST, GARFIELD, NJ 07026-1358
(973) 330-3557
Mailing address
702 SW 8TH ST, BENTONVILLE, AR 72716-0445
(479) 277-1238
(479) 277-4331
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
3336C0003X
Community/Retail Pharmacy
Primary
28RS00706000
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0255521
—
NJ
01
—
2125812
PK
—
Enumeration date
06/30/2010
Last updated
07/08/2025
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