# WALMART INC.

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- **Entity:** Organization
- **Status:** Active
- **Other names:** WalMart Pharmacy 10-7043
- **Organization subpart:** No

## Provider details

- **NPI number:** 1407251770
- **Authorized official:** KIMBERLY CANONIC (SENIOR DIRECTOR, ENROLLMENT)
- **Authorized official phone:** (480) 277-6348

## Contact information

- **Practice address:** 1202 W 12600 S, RIVERTON, UT 84065-7094
- **Practice address phone:** (479) 258-2115
- **Mailing address:** 1 CUSTOMER DR, MS 0445, BENTONVILLE, AR 72716-0445

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 332B00000X | Durable Medical Equipment & Medical Supplies | — | NULL | — |
| 3336C0003X | Community/Retail Pharmacy | 9207703-1703 | UT | Yes |

## Other

- **Enumeration date:** 10/29/2014
- **Last updated:** 06/15/2026

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 1407251770 | — | UT |
| 01 | — | 2148702 | PK | — |