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Organization
WALMART INC
Active
Organization
WALMART INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KIMBERLY CANONIC (SENIOR DIRECTOR, ENROLLMENT)
(480) 853-0515
Entity
Organization
Contact information
Practice address
1791 ENSIGN LANE SE, WARRENTON, OR 97146-7339
(503) 861-0644
(503) 861-0897
Mailing address
702 SW 8TH ST, BENTONVILLE, AR 72716-0445
(479) 277-1242
(479) 277-4331
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
333600000X
Pharmacy
Primary
RP-0003387
OR
3336C0003X
Community/Retail Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2103875
—
WA
01
—
2176573
PK
—
05
—
500745490
—
OR
Enumeration date
03/08/2018
Last updated
06/12/2025
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