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Organization
WALMART INC.
Active
Organization
WALMART INC.
Active
Other names
WALMART PHARMACY 10-1692
Organization subpart
No
Provider details
NPI number
Authorized official
KIMBERLY CANONIC (SENIOR DIRECTOR, ENROLLMENT)
(480) 853-0515
Entity
Organization
Contact information
Practice address
1120 S MOUNT VERNON AVE, COLTON, CA 92324-4220
(909) 783-0390
(909) 783-9318
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
PHY37621
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2115927
PK
—
05
—
463PHA376210
—
CA
Enumeration date
07/16/2006
Last updated
07/07/2025
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