# WALMART INC.

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Walmart Pharmacy 10-4068
- **Organization subpart:** No

## Provider details

- **NPI number:** 1023407533
- **Authorized official:** KIMBERLY CANONIC (SENIOR DIRECTOR, ENROLLMENT)
- **Authorized official phone:** (480) 277-6348

## Contact information

- **Practice address:** 1206 N CANYON CREEK PKWY, SPANISH FORK, UT 84660-1319
- **Practice address phone:** (801) 702-4974
- **Practice address fax:** (801) 702-1973
- **Mailing address:** 702 SW 8TH ST, BENTONVILLE, AR 72716-0445
- **Mailing address phone:** (479) 258-2115
- **Mailing address fax:** (479) 277-4331

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 332B00000X | Durable Medical Equipment & Medical Supplies | — | NULL | — |
| 3336C0003X | Community/Retail Pharmacy | 9213109-1703 | UT | Yes |

## Other

- **Enumeration date:** 01/21/2015
- **Last updated:** 06/06/2025

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 2149810 | PK | — |