Organization
WALMART INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KIMBERLY CANONIC (SENIOR DIRECTOR, ENROLLMENT)
(480) 277-6348
Entity
Organization
Contact information
Practice address
1410 N MARKET ST, SPARTA, IL 62286-2302
(618) 443-2436
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
54009217
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2019388
PK
—
Enumeration date
07/16/2006
Last updated
05/29/2025
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