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Organization
WALMART INC.
Active
Organization
WALMART INC.
Active
Other names
WALMART PHARMACY 10-2333
Organization subpart
No
Provider details
NPI number
Authorized official
KIMBERLY CANONIC (SENIOR DIRECTOR, ENROLLMENT)
(480) 853-0515
Entity
Organization
Contact information
Practice address
20251 US HIGHWAY 18, APPLE VALLEY, CA 92307-2953
(760) 946-2430
(760) 946-1011
Mailing address
702 SW 8TH ST, BENTONVILLE, AR 72716-0445
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
PHY41847
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2077851
PK
—
05
—
463PHA418470
—
CA
Enumeration date
07/17/2006
Last updated
06/18/2025
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