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Organization
WALMART INC.
Active
Organization
WALMART INC.
Active
Other names
WALMART PHARMACY 10-2292
Organization subpart
No
Provider details
NPI number
Authorized official
KIMBERLY CANONIC (SR. DIRECTOR)
(479) 371-1168
Entity
Organization
Contact information
Practice address
1275 N AZUSA AVE, COVINA, CA 91722-1246
(626) 339-6912
(626) 339-6203
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
PHY43288
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2002212
PK
—
05
—
463PHA432880
—
CA
Enumeration date
07/16/2006
Last updated
09/29/2025
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