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Organization
WALMART INC.
Active
Organization
WALMART INC.
Active
Other names
WalMart Pharmacy 10-5434
Organization subpart
No
Provider details
NPI number
Authorized official
KIMBERLY CANONIC (SENIOR DIRECTOR, ENROLLMENT)
(480) 853-0515
Entity
Organization
Contact information
Practice address
15555 HESPERIAN BLVD, SAN LEANDRO, CA 94579-1801
(510) 351-0132
(510) 667-0458
Mailing address
702 SW 8TH ST, BENTONVILLE, AR 72716-0445
(479) 277-1238
(479) 277-4331
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
49273
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1417192634
—
CA
01
—
2118200
PK
—
Enumeration date
12/03/2008
Last updated
06/16/2025
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