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Organization
WALMART INC.
Active
Organization
WALMART INC.
Active
Other names
WALMART PHARMACY 10-1979
Organization subpart
No
Provider details
NPI number
Authorized official
KIMBERLY CANONIC (SENIOR DIRECTOR, ENROLLMENT)
(480) 277-6348
Entity
Organization
Contact information
Practice address
15960 DAM RD, CLEARLAKE, CA 95422-7906
(707) 994-1671
(707) 994-1673
Mailing address
702 SW 8TH ST, BENTONVILLE, AR 72716-0445
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
PHY39666
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2103327
PK
—
05
—
463PHA395480
—
CA
05
—
463PHA396660
—
CA
Enumeration date
07/17/2006
Last updated
06/09/2025
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