Organization
WALMART INC.
Active
Other names
WALMART PHARMACY 10-3705
Organization subpart
No
Provider details
NPI number
Authorized official
KIMBERLY CANONIC (SENIOR DIRECTOR, ENROLLMENT)
(480) 277-6348
Entity
Organization
Contact information
Practice address
17100 STATE ROUTE 507 SE, YELM, WA 98597-7605
(360) 400-8062
Mailing address
702 SW 8TH ST, BENTONVILLE, AR 72716-0445
(479) 277-1242
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
3336C0003X
Community/Retail Pharmacy
Primary
CF00059080
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2109086
PK
—
05
—
6030621
—
WA
Enumeration date
06/01/2007
Last updated
07/07/2025
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