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Organization
WALMART INC.
Active
Organization
WALMART INC.
Active
Other names
WalMart Pharmacy 10-3023
Organization subpart
No
Provider details
NPI number
Authorized official
KIMBERLY CANONIC (SENIOR DIRECTOR, ENROLLMENT)
(480) 277-6348
Entity
Organization
Contact information
Practice address
4055 EVERGREEN VILLAGE SQ, SAN JOSE, CA 95135-1764
(408) 826-0341
(408) 826-3042
Mailing address
1 CUSTOMER DR, MS 0445, BENTONVILLE, AR 72716-0445
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
PHY51219
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2138063
PK
—
Enumeration date
11/19/2012
Last updated
09/29/2025
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