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Organization
WALMART INC.
Active
Organization
WALMART INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KIMBERLY CANONIC (SENIOR DIRECTOR, ENROLLMENT)
(480) 853-0515
Entity
Organization
Contact information
Practice address
2225 W MARKET ST, BLOOMINGTON, IL 61705-5014
(309) 828-8626
Mailing address
702 SW 8TH ST, BENTONVILLE, AR 72716-0445
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
NULL
333600000X
Pharmacy
—
NULL
3336C0003X
Community/Retail Pharmacy
Primary
54014865
IL
Other
Enumeration date
07/16/2006
Last updated
06/19/2025
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