Organization
WALMART INC.
Active
Other names
WalMart Pharmacy 10-4138
Organization subpart
No
Provider details
NPI number
Authorized official
KIMBERLY CANONIC (SENIOR DIRECTOR, ENROLLMENT)
(480) 277-6348
Entity
Organization
Contact information
Practice address
13105 BIRCH DR, OMAHA, NE 68164-5222
(402) 686-2058
(402) 493-0730
Mailing address
702 SW 8TH ST, BENTONVILLE, AR 72716-0445
(479) 204-8741
(479) 277-4331
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
2961
NE
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100262713-00
—
NE
01
—
2138827
PK
—
Enumeration date
01/28/2013
Last updated
06/05/2025
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