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Organization
WALMART INC.
Active
Organization
WALMART INC.
Active
Other names
Walmart Pharmacy 10-5632
Organization subpart
No
Provider details
NPI number
Authorized official
KIMBERLY CANONIC (SR. DIRECTOR)
(479) 371-1168
Entity
Organization
Contact information
Practice address
1804 E ASHLAN AVE, FRESNO, CA 93726-2019
(559) 470-6967
(559) 470-6970
Mailing address
1 CUSTOMER DR, MS 0445, BENTONVILLE, AR 72716-0445
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
3336C0003X
Community/Retail Pharmacy
Primary
51972
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1609287127
—
CA
01
—
2146175
PK
—
Enumeration date
05/19/2014
Last updated
09/29/2025
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