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Organization
WALMART INC.
Active
Organization
WALMART INC.
Active
Other names
WalMart Pharmacy 10-3046
Organization subpart
No
Provider details
NPI number
Authorized official
KIMBERLY CANONIC (SENIOR DIRECTOR, ENROLLMENT)
(480) 277-6348
Entity
Organization
Contact information
Practice address
1421 COFFEE RD, MODESTO, CA 95355-3170
(209) 222-5616
(209) 222-5557
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
PHY51063
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1508121914
—
CA
01
—
2136137
PK
—
Enumeration date
07/11/2012
Last updated
06/06/2025
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