Organization
WALMART INC.
Active
Other names
WalMart Pharmacy 10-4849
Organization subpart
No
Provider details
NPI number
Authorized official
KIMBERLY CANONIC (SENIOR DIRECTOR, ENROLLMENT)
(480) 277-6348
Entity
Organization
Contact information
Practice address
8580 ROCK RIDGE DR, MOUNTAIN IRON, MN 55768-2800
(218) 305-3321
(218) 305-3315
Mailing address
702 SW 8TH ST, BENTONVILLE, AR 72716-0445
(479) 258-2115
(479) 277-4331
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
3336C0003X
Community/Retail Pharmacy
Primary
264519
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1093125155
—
MN
01
—
2145735
PK
—
Enumeration date
04/29/2014
Last updated
06/09/2025
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