Organization
WALMART INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KIMBERLY CANONIC (SENIOR DIRECTOR, ENROLLMENT)
(480) 277-6348
Entity
Organization
Contact information
Practice address
175 N MIDDLETON RD, NAMPA, ID 83651-7538
(208) 546-3396
(208) 546-3338
Mailing address
702 SW 8TH ST, BENTONVILLE, AR 72716-0445
(479) 204-8550
(479) 277-4331
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
3336C0003X
Community/Retail Pharmacy
Primary
35993RP
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2145078
PK
—
Enumeration date
04/02/2014
Last updated
06/05/2025
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