Wal-Mart Stores East LP
Organization Active NPI Community/Retail Pharmacy · Kearny, NJ
NPI 1669414660 · NPPES record last updated Jun 13, 2025
Key facts
- NPI
- 1669414660
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Community/Retail Pharmacy 3336C0003X
- License
- 28RS00661900 (NJ)
- Legal business name
- WAL-MART STORES EAST LP
- Practice address
- 150 Harrison Ave
Kearny, NJ 07032-5950 - Phone
- (201) 955-0162
- NPI assigned
- Jun 12, 2006
- Organization subpart
- No
Authorized official
- Name
- Kimberly Canonic
- Title
- Senior Director, Enrollment
- Phone
- (480) 853-0515
Corporate family (same tax ID) 24
Member of 2
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in NJ
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20100930093612 | NJ | DME Supplier - Pharmacy |
6204749997 | Practice locations: Kearny, NJ |
| O20130830000234 | NJ | Part B Supplier - Mass Immunization (Roster Biller Only) | 6204749997 | This NPI is an additional NPI on the enrollment |
National Provider Directory
- Tax ID family
- Ability Network
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Durable Medical Equipment & Medical Supplies | 332B00000X | |||
| Community/Retail Pharmacy | 3336C0003X | 28RS00661900 | NJ | Yes |
Addresses
Primary practice location
150 Harrison Ave
Kearny, NJ 07032-5950
Mailing address
702 SW 8TH St
Bentonville, AR 72716-0445
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0105597 | Medicaid | NJ | |
| 2055939 | Other | PK |
Other names
- WALMART PHARMACY 10-5447
Electronic endpoints
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| CONNECT URL | https://esmd.abilitynetwork.com:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRRequest_Service | Other | Ability Network |
Other providers in Kearny, NJ
- Rajarajeswari Velusamy
- Patrick Alexandro Vera
- Tania Vicente Carballo
- Kaylan Vicente
- Carlos Andres Villafuerte
- Wal-Mart Stores East, LP
- Walgreen Co
- Walgreen Co
- Walgreen Co
- Anthony John Walko III
All providers in Kearny, NJ · Community/Retail Pharmacy in New Jersey
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 13, 2025. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.