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Organization
WALMART INC.
Active
Organization
WALMART INC.
Active
Other names
WALMART PHARMACY 10-4309
Organization subpart
No
Provider details
NPI number
Authorized official
KIMBERLY CANONIC (SENIOR DIRECTOR, ENROLLMENT)
(480) 853-0515
Entity
Organization
Contact information
Practice address
8961 GREENBACK LN, ORANGEVALE, CA 95662-4601
(916) 989-9380
(916) 989-9382
Mailing address
702 SW 8TH ST, BENTONVILLE, AR 72716-0446
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
3336C0003X
Community/Retail Pharmacy
Primary
PHY49017
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2113479
PK
—
05
—
PHA490170
—
CA
Enumeration date
01/16/2008
Last updated
07/08/2025
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