# WALMART INC.

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- **Entity:** Organization
- **Status:** Active
- **Other names:** WalMart Pharmacy 10-5763
- **Organization subpart:** No

## Provider details

- **NPI number:** 1689912594
- **Authorized official:** KIMBERLY CANONIC (SENIOR DIRECTOR, ENROLLMENT)
- **Authorized official phone:** (480) 853-0515

## Contact information

- **Practice address:** 3590 W SOUTH JORDAN PKWY, SOUTH JORDAN, UT 84095-8916
- **Practice address phone:** (801) 601-3119
- **Mailing address:** 702 SW 8TH ST, BENTONVILLE, AR 72716

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 332B00000X | Durable Medical Equipment & Medical Supplies | — | NULL | — |
| 3336C0003X | Community/Retail Pharmacy | 8528037-1703 | UT | Yes |

## Other

- **Enumeration date:** 01/28/2013
- **Last updated:** 06/16/2025

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 2138832 | PK | — |