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Organization
WALMART INC.
Active
Organization
WALMART INC.
Active
Other names
WALMART PHARMACY 10-2025
Organization subpart
No
Provider details
NPI number
Authorized official
KIMBERLY CANONIC (SENIOR DIRECTOR, ENROLLMENT)
(480) 277-6348
Entity
Organization
Contact information
Practice address
3010 W GRANT LINE RD, TRACY, CA 95304-9402
(209) 836-1991
(209) 836-9354
Mailing address
702 SW 8TH ST, BENTONVILLE, AR 72716-0445
(479) 204-3559
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
PHY39490
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2076841
PK
—
05
—
463PHA394900
—
CA
Enumeration date
07/16/2006
Last updated
06/06/2025
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