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Organization
WALMART INC.
Active
Organization
WALMART INC.
Active
Other names
Walmart Pharmacy 10-4392
Organization subpart
No
Provider details
NPI number
Authorized official
KIMBERLY CANONIC (SENIOR DIRECTOR, ENROLLMENT)
(480) 853-0515
Entity
Organization
Contact information
Practice address
12234 PALMDALE RD, VICTORVILLE, CA 92392-9418
(760) 493-3279
(760) 962-9167
Mailing address
702 SW 8TH ST, BENTONVILLE, AR 72716-0445
(479) 277-1240
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
PHY51798
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2144433
PK
—
Enumeration date
02/24/2014
Last updated
07/10/2025
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