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Organization
WALMART INC.
Active
Organization
WALMART INC.
Active
Other names
WalMart Pharmacy 10-5684
Organization subpart
No
Provider details
NPI number
Authorized official
KIMBERLY CANONIC (SENIOR DIRECTOR, ENROLLMENT)
(480) 277-6348
Entity
Organization
Contact information
Practice address
8810 GROSSMONT BLVD, LA MESA, CA 91942-9027
(619) 403-5397
(619) 403-5393
Mailing address
702 SW 8TH ST, BENTONVILLE, AR 72716-6209
(479) 277-1238
(479) 277-4331
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
3336C0003X
Community/Retail Pharmacy
Primary
PHY51076
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1427306489
—
CA
01
—
2136617
PK
—
Enumeration date
08/23/2012
Last updated
06/05/2025
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