Organization
WALMART INC.
Active
Other names
WALMART PHARMACY 10-3604
Organization subpart
No
Provider details
NPI number
Authorized official
KIMBERLY CANONIC (SENIOR DIRECTOR, ENROLLMENT)
(480) 277-6348
Entity
Organization
Contact information
Practice address
14200 W INDIAN SCHOOL RD, GOODYEAR, AZ 85395-9248
(623) 935-7578
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
Y004379
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
079536
—
AZ
01
—
1991959
PK
—
05
—
YO4379
—
AZ
Enumeration date
01/03/2007
Last updated
07/02/2025
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