Organization
WALMART INC.
Active
Other names
WalMart Pharmacy 10-3146
Organization subpart
No
Provider details
NPI number
Authorized official
KIMBERLY CANONIC (SENIOR DIRECTOR, ENROLLMENT)
(480) 277-6348
Entity
Organization
Contact information
Practice address
1840 NW 9TH ST, CORVALLIS, OR 97330-2143
(541) 224-0039
Mailing address
702 SW 8TH ST, BENTONVILLE, AR 72716-0445
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
3336C0003X
Community/Retail Pharmacy
Primary
RP-0002769-CS
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2138834
PK
—
05
—
500656090
—
OR
Enumeration date
01/28/2013
Last updated
06/06/2025
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