Organization
WALMART INC.
Active
Other names
WALMART PHARMACY 10-3728
Organization subpart
No
Provider details
NPI number
Authorized official
KIMBERLY CANONIC (SENIOR DIRECTOR, ENROLLMENT)
(480) 853-0515
Entity
Organization
Contact information
Practice address
3950 W LAKE MEAD BLVD, NORTH LAS VEGAS, NV 89032-4895
(702) 631-6806
(702) 631-7983
Mailing address
702 SW 8TH STREET, BENTONVILLE, AR 72716-0445
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
3336C0003X
Community/Retail Pharmacy
Primary
PH02226
NV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100511773
—
NV
01
—
2052225
PK
—
Enumeration date
03/15/2007
Last updated
07/08/2025
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