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Organization
WALMART INC.
Active
Organization
WALMART INC.
Active
Other names
WALMART PHARMACY 10-2077
Organization subpart
No
Provider details
NPI number
Authorized official
KIMBERLY CANONIC (SENIOR DIRECTOR, ENROLLMENT)
(480) 277-6348
Entity
Organization
Contact information
Practice address
29260 CENTRAL AVE, LAKE ELSINORE, CA 92532-2232
(951) 245-4329
(951) 245-2851
Mailing address
702 SW 8TH ST, BENTONVILLE, AR 72716-0445
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
PHY40343
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1990962
PK
—
05
—
463PHA403430
—
CA
Enumeration date
07/16/2006
Last updated
06/05/2025
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