Organization
WALMART INC.
Active
Other names
WalMart Pharmacy 10-4395
Organization subpart
No
Provider details
NPI number
Authorized official
KIMBERLY CANONIC (SENIOR DIRECTOR, ENROLLMENT)
(480) 853-0515
Entity
Organization
Contact information
Practice address
6405 W POINTE PKWY, POST FALLS, ID 83854-6948
(208) 777-4214
(208) 777-4234
Mailing address
702 SW 8TH ST, BENTONVILLE, AR 72716-0445
(479) 204-8550
(479) 277-4331
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
3336C0003X
Community/Retail Pharmacy
Primary
14475RP
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1134430713
—
ID
05
—
1134430713
—
WA
01
—
2125808
PK
—
Enumeration date
06/29/2010
Last updated
07/10/2025
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