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Organization
WALMART INC.
Active
Organization
WALMART INC.
Active
Other names
WalMart Pharmacy 10-3090
Organization subpart
No
Provider details
NPI number
Authorized official
KIMBERLY CANONIC (SENIOR DIRECTOR, ENROLLMENT)
(480) 277-6348
Entity
Organization
Contact information
Practice address
5609 PACIFIC ST, ROCKLIN, CA 95677-3174
(916) 824-0122
(916) 824-0123
Mailing address
702 SW 8TH ST, BENTONVILLE, AR 72716-0445
(479) 277-3348
(479) 277-4331
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
3336C0003X
Community/Retail Pharmacy
Primary
PHY51573
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2141153
PK
—
Enumeration date
07/10/2013
Last updated
06/06/2025
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