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 10-2842
Organization subpart
No
Provider details
NPI number
Authorized official
KIMBERLY CANONIC (SR DIRECTOR)
(479) 371-1168
Entity
Organization
Contact information
Practice address
1290 E ONTARIO AVE, CORONA, CA 92881-3618
(951) 278-1645
(951) 278-2127
Mailing address
1 CUSTOMER DR, MS 0445, BENTONVILLE, AR 72716-0445
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
PHY45230
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1996961
PK
—
05
—
463PHA452300
—
CA
Enumeration date
07/16/2006
Last updated
09/29/2025
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