Organization
WALMART INC.
Active
Other names
WALMART PHARMACY 10-5462
Organization subpart
No
Provider details
NPI number
Authorized official
KIMBERLY CANONIC (SENIOR DIRECTOR, ENROLLMENT)
(480) 853-0515
Entity
Organization
Contact information
Practice address
430 SE 192ND AVE, VANCOUVER, WA 98683-9531
(360) 256-6361
Mailing address
702 SW 8TH STREET, BENTONVILLE, AR 72716-0445
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
CF00058464
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2108600
PK
—
05
—
6028880
—
WA
05
—
CF00058464
—
WA
Enumeration date
07/16/2006
Last updated
06/13/2025
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