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Organization
WALMART INC.
Active
Organization
WALMART INC.
Active
Other names
WALMART PHARMACY 10-2609
Organization subpart
No
Provider details
NPI number
Authorized official
KIMBERLY CANONIC (SR. DIRECTOR)
(479) 371-1168
Entity
Organization
Contact information
Practice address
2770 CARSON ST, LAKEWOOD, CA 90712-4004
(562) 429-9960
(562) 429-7530
Mailing address
1 CUSTOMER DR, MS 0445, BENTONVILLE, AR 72716-0445
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
PHY44615
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2094474
PK
—
05
—
463PHA446150
—
CA
Enumeration date
07/16/2006
Last updated
09/29/2025
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