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
5469 S REDWOOD RD, TAYLORSVILLE, UT 84123-5318
(801) 264-9797
Mailing address
702 SW 8TH ST, BENTONVILLE, AR 72716-0445
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
59451571703
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1043237233
—
OR
01
—
2099819
PK
—
Enumeration date
07/16/2006
Last updated
07/08/2025
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