Organization
WALMART INC.
Active
Other names
WALMART PHARMACY 10-1604
Organization subpart
No
Provider details
NPI number
Authorized official
KIMBERLY CANONIC (SENIOR DIRECTOR, ENROLLMENT)
(480) 277-6348
Entity
Organization
Contact information
Practice address
1200 N LACROSSE ST, RAPID CITY, SD 57701-6965
(605) 342-0881
Mailing address
702 SW 8TH STREET, BENTONVILLE, AR 72716-0445
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
1001513
SD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2094202
PK
—
05
—
8503650
—
SD
Enumeration date
07/16/2006
Last updated
08/06/2025
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