| Organization Name: | WAL-MART PHARMACY STORE 3422 |
| NPI Number: | 1093086019 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | HUAHUA SHI (PHARMACY MANAGER) |
| Mailing Address: | 2000 Clements Bridge Rd Deptford |
| State: | NJ US |
| Postal Code: | 080962016 |
| Phone Number: | 8563846740 |
| Fax Number: | 8563846742 |
| NPI Enumeration Date: | 01/23/2012 |
| NPI Last Update Date: | 01/23/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QC1500X |
| License Number: | 28R103317000 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NJ |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Community Health |
| Taxonomy Definition: | |