Organization
WALMART INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KIMBERLY CANONIC (SENIOR DIRECTOR, ENROLLMENT)
(480) 853-0515
Entity
Organization
Contact information
Practice address
4650 W NORTH AVE, CHICAGO, IL 60639-4611
(773) 252-7769
Mailing address
702 SW 8TH ST, BENTONVILLE, AR 72716-0445
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
3336C0003X
Community/Retail Pharmacy
Primary
054015830
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2023201
PK
—
Enumeration date
08/10/2006
Last updated
06/13/2025
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