Is this information incorrect? This page shows public data from NPPES. Update your record in NPPES and this page will update automatically within 7 days.
Organization
WALMART INC.
Active
Organization
WALMART INC.
Active
Other names
WalMart Pharmacy 10-4340
Organization subpart
No
Provider details
NPI number
Authorized official
KIMBERLY CANONIC (SENIOR DIRECTOR, ENROLLMENT)
(480) 853-0515
Entity
Organization
Contact information
Practice address
13401 MAIN ST, HESPERIA, CA 92345-9123
(760) 244-7035
(760) 956-4936
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
PHY51066
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1578818209
—
CA
01
—
2136100
PK
—
Enumeration date
07/18/2012
Last updated
07/09/2025
About Stedi
Stedi is the only programmable healthcare clearinghouse. You can use Stedi's APIs to process eligibility checks, claims, remits, and more.
Sign up