# WALMART INC.

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- **Entity:** Organization
- **Status:** Active
- **Other names:** WalMart Pharmacy 10-5396
- **Organization subpart:** No

## Provider details

- **NPI number:** 1790062297
- **Authorized official:** KIMBERLY CANONIC (SENIOR DIRECTOR, ENROLLMENT)
- **Authorized official phone:** (480) 853-0515

## Contact information

- **Practice address:** 1330 GOLDFISH FARM RD SE, ALBANY, OR 97322-5154
- **Practice address phone:** (541) 971-4062
- **Mailing address:** 702 SW 8TH ST, BENTONVILLE, AR 72716
- **Mailing address phone:** (479) 277-1238
- **Mailing address fax:** (479) 277-4331

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 332B00000X | Durable Medical Equipment & Medical Supplies | — | NULL | — |
| 3336C0003X | Community/Retail Pharmacy | RP0002685 | OR | Yes |

## Other

- **Enumeration date:** 11/11/2011
- **Last updated:** 06/13/2025

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 2132660 | PK | — |