# WALMART INC.

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Walmart Pharmacy 10-4221
- **Organization subpart:** No

## Provider details

- **NPI number:** 1356652077
- **Authorized official:** KIMBERLY CANONIC (SENIOR DIRECTOR ENROLLMENT)
- **Authorized official phone:** (479) 371-1168

## Contact information

- **Practice address:** 220 N ADAIR ST, CORNELIUS, OR 97113-8404
- **Practice address phone:** (503) 207-0635
- **Mailing address:** 702 SW 8TH ST., BENTONVILLE, AR 72716-6209
- **Mailing address phone:** (479) 277-1238
- **Mailing address fax:** (479) 277-4331

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 332B00000X | Durable Medical Equipment & Medical Supplies | — | NULL | — |
| 3336C0003X | Community/Retail Pharmacy | RP-0002612-CS | OR | Yes |

## Other

- **Enumeration date:** 06/28/2010
- **Last updated:** 07/09/2025

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 2125806 | PK | — |
| 05 | — | 500632409 | — | OR |