Organization
WALMART INC.
Active
Other names
WalMart Pharmacy 10-3126
Organization subpart
No
Provider details
NPI number
Authorized official
KIMBERLY CANONIC (SENIOR DIRECTOR, ENROLLMENT)
(480) 277-6348
Entity
Organization
Contact information
Practice address
16746 E SMOKY HILL RD, CENTENNIAL, CO 80015-2472
(303) 305-1115
Mailing address
702 SW 8TH ST, BENTONVILLE, AR 72716-6209
(479) 277-1238
(479) 277-4331
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
3336C0003X
Community/Retail Pharmacy
Primary
0000000846
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2134860
PK
—
05
—
67234755
—
CO
Enumeration date
04/23/2012
Last updated
06/05/2025
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