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
622 W USTICK RD, CALDWELL, ID 83605-6248
(208) 453-2852
(208) 453-8985
Mailing address
702 SW 8TH ST, BENTONVILLE, AR 72716-0445
(479) 277-1242
(479) 277-4331
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
42854RP
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1093163990
—
ID
01
—
2160484
PK
—
Enumeration date
06/01/2016
Last updated
06/10/2025
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