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Organization
WALMART INC.
Active
Organization
WALMART INC.
Active
Other names
WalMart Pharmacy 10-5638
Organization subpart
No
Provider details
NPI number
Authorized official
KIMBERLY CANONIC (SENIOR DIRECTOR, ENROLLMENT)
(480) 277-6348
Entity
Organization
Contact information
Practice address
2121 IMPERIAL AVE, SAN DIEGO, CA 92102-3826
(619) 849-5834
(619) 849-5835
Mailing address
702 SW 8TH ST, BENTONVILLE, AR 72716-0445
(479) 204-8741
(479) 277-4331
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
3336C0003X
Community/Retail Pharmacy
Primary
PHY51223
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2140366
PK
—
Enumeration date
05/13/2013
Last updated
06/05/2025
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