Organization
WALMART INC.
Active
Other names
Walmart Pharmacy 10-4700
Organization subpart
No
Provider details
NPI number
Authorized official
KIMBERLY CANONIC (SENIOR DIRECTOR, ENROLLMENT)
(480) 277-6348
Entity
Organization
Contact information
Practice address
1707 W STATE RD, PLEASANT GROVE, UT 84062-5045
(801) 216-0003
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
9025643-1703
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1053723841
—
UT
01
—
2146103
PK
—
Enumeration date
05/28/2014
Last updated
06/05/2025
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