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Organization
WALMART INC.
Active
Organization
WALMART INC.
Active
Other names
WALMART PHARMACY 10-2457
Organization subpart
No
Provider details
NPI number
Authorized official
KIMBERLY CANONIC (SENIOR DIRECTOR, ENROLLMENT)
(480) 277-6348
Entity
Organization
Contact information
Practice address
10655 FOLSOM BLVD, RANCHO CORDOVA, CA 95670-4828
(916) 361-0515
(916) 361-0739
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
PHY45255
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1997142
PK
—
05
—
463PHA452550
—
CA
Enumeration date
07/16/2006
Last updated
05/29/2025
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