Organization
WALMART INC.
Active
Other names
WALMART PHARMACY 10-1843
Organization subpart
No
Provider details
NPI number
Authorized official
KIMBERLY CANONIC (SENIOR DIRECTOR, ENROLLMENT)
(480) 853-0515
Entity
Organization
Contact information
Practice address
2375 NORTH 99 W, MCMINNVILLE, OR 97128
(503) 434-6854
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
RP-0001263-CS
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
050240
—
OR
01
—
2078274
PK
—
05
—
50240
—
OR
Enumeration date
07/18/2006
Last updated
06/16/2025
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