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Organization
WALMART INC.
Active
Organization
WALMART INC.
Active
Other names
WalMart Pharmacy 10-4169
Organization subpart
No
Provider details
NPI number
Authorized official
KIMBERLY CANONIC (SENIOR DIRECTOR, ENROLLMENT)
(480) 277-6348
Entity
Organization
Contact information
Practice address
300 N 2ND ST, EL CAJON, CA 92021-6444
(619) 219-5252
(619) 219-5253
Mailing address
702 SW 8TH STREET, BENTONVILLE, AR 72716-0445
(479) 258-2115
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
3336C0003X
Community/Retail Pharmacy
Primary
51744
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1528480613
—
CA
01
—
2143879
PK
—
Enumeration date
01/09/2014
Last updated
06/05/2025
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