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Organization
WALMART INC.
Active
Organization
WALMART INC.
Active
Other names
WALMART PHARMACY 10-1793
Organization subpart
No
Provider details
NPI number
Authorized official
KIMBERLY CANONIC (SENIOR DIRECTOR, ENROLLMENT)
(480) 853-0515
Entity
Organization
Contact information
Practice address
3002 STACY ALLISON WAY, WOODBURN, OR 97071-2904
(503) 981-9625
Mailing address
702 SW 8TH ST, BENTONVILLE, AR 72716-0445
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
NULL
333600000X
Pharmacy
—
NULL
3336C0003X
Community/Retail Pharmacy
Primary
0001256CS
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
047626
—
OR
01
—
2078273
PK
—
05
—
47626
—
OR
Enumeration date
07/16/2006
Last updated
06/17/2025
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