Organization
WALMART INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KIMBERLY CANONIC (SENIOR DIRECTOR, ENROLLMENT)
(480) 277-6348
Entity
Organization
Contact information
Practice address
3180 S 5600 W, WEST VALLEY CITY, UT 84120-1300
(801) 966-4492
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
—
—
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
51674131703
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2101077
PK
—
Enumeration date
07/16/2006
Last updated
07/01/2025
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