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Organization
WALMART INC.
Active
Organization
WALMART INC.
Active
Other names
WALMART PHARMACY 10-1881
Organization subpart
No
Provider details
NPI number
Authorized official
KIMBERLY CANONIC (SENIOR DIRECTOR, ENROLLMENT)
(480) 853-0515
Entity
Organization
Contact information
Practice address
7901 WATT AVE, ANTELOPE, CA 95843-2000
(916) 332-4427
(916) 332-4130
Mailing address
1 CUSTOMER DR, MS 0445, BENTONVILLE, AR 72716-0445
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
PHY38993
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2043384
PK
—
05
—
463PHA389930
—
CA
05
—
463PHA389939
—
CA
Enumeration date
07/16/2006
Last updated
09/29/2025
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