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Organization
WALMART INC.
Active
Organization
WALMART INC.
Active
Other names
WalMart Pharmacy 10-5335
Organization subpart
No
Provider details
NPI number
Authorized official
KIMBERLY CANONIC (SENIOR DIRECTOR, ENROLLMENT)
(480) 853-0515
Entity
Organization
Contact information
Practice address
250 WILDCAT DR, BRAWLEY, CA 92227-9654
(760) 351-1650
(760) 351-1682
Mailing address
702 SW 8TH ST, BENTONVILLE, AR 72716-0445
(479) 277-1238
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
3336C0003X
Community/Retail Pharmacy
Primary
49174
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1598941072
—
CA
01
—
2117035
PK
—
Enumeration date
01/15/2008
Last updated
06/13/2025
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