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Organization
WALMART INC.
Active
Organization
WALMART INC.
Active
Other names
WalMart Pharmacy 10-5710
Organization subpart
No
Provider details
NPI number
Authorized official
KIMBERLY CANONIC (SENIOR DIRECTOR, ENROLLMENT)
(480) 853-0515
Entity
Organization
Contact information
Practice address
3848 MCHENRY AVE, MODESTO, CA 95356-1586
(209) 342-0960
(209) 342-0962
Mailing address
1 CUSTOMER DR, MS 0445, BENTONVILLE, AR 72716-0445
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
3336C0003X
Community/Retail Pharmacy
Primary
PHY49198
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1225287352
—
CA
01
—
2117280
PK
—
Enumeration date
09/12/2008
Last updated
09/29/2025
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