Organization
WALMART INC.
Active
Other names
WALMART PHARMACY 10-3355
Organization subpart
No
Provider details
NPI number
Authorized official
KIMBERLY CANONIC (SENIOR DIRECTOR, ENROLLMENT)
(480) 853-0515
Entity
Organization
Contact information
Practice address
1400 S LAMB BLVD, LAS VEGAS, NV 89104-5416
(702) 431-5004
Mailing address
702 SW 8TH STREET, BENTONVILLE, AR 72716-0445
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
3336C0003X
Community/Retail Pharmacy
Primary
PH02153
NV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100510069
—
NV
01
—
2052186
PK
—
Enumeration date
07/16/2006
Last updated
06/19/2025
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