Organization
WALMART INC.
Active
Other names
WalMart Pharmacy 10-4471
Organization subpart
No
Provider details
NPI number
Authorized official
KIMBERLY CANONIC (SENIOR DIRECTOR, ENROLLMENT)
(480) 853-0515
Entity
Organization
Contact information
Practice address
2390 E CEDAR ST, RAWLINS, WY 82301-6026
(307) 417-3058
(307) 417-3007
Mailing address
702 SW 8TH ST, BENTONVILLE, AR 72716-0445
(479) 258-2115
(479) 277-4331
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
3336C0003X
Community/Retail Pharmacy
Primary
R10124
WY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
138281100
—
WY
01
—
2147184
PK
—
Enumeration date
08/01/2014
Last updated
07/14/2025
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