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Organization
WALMART INC.
Active
Organization
WALMART INC.
Active
Other names
WalMart Pharmacy 10-2181
Organization subpart
No
Provider details
NPI number
Authorized official
KIMBERLY CANONIC (SENIOR DIRECTOR, ENROLLMENT)
(480) 277-6348
Entity
Organization
Contact information
Practice address
82491 AVENUE 42, INDIO, CA 92203-9307
(760) 262-5830
(760) 262-8517
Mailing address
702 SW 8TH ST, BENTONVILLE, AR 72716-0445
(479) 258-2115
(479) 277-4331
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
3336C0003X
Community/Retail Pharmacy
Primary
PHY52007
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1861892754
—
CA
01
—
2147618
PK
—
Enumeration date
08/27/2014
Last updated
06/02/2025
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