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Organization
WALMART INC.
Active
Organization
WALMART INC.
Active
Other names
WALMART PHARMACY 10-3455
Organization subpart
No
Provider details
NPI number
Authorized official
KIMBERLY CANONIC (SENIOR DIRECTOR, ENROLLMENT)
(480) 853-0515
Entity
Organization
Contact information
Practice address
1400 HILLTOP MALL RD, RICHMOND, CA 94806-1913
(510) 669-0386
(510) 669-0413
Mailing address
702 SW 8TH ST, BENTONVILLE, AR 72716-0445
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
3336C0003X
Community/Retail Pharmacy
Primary
PHY48562
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2112264
PK
—
Enumeration date
03/14/2007
Last updated
06/19/2025
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