Organization
WALMART INC.
Active
Other names
WALMART PHARMACY 10-1901
Organization subpart
No
Provider details
NPI number
Authorized official
KIMBERLY CANONIC (SENIOR DIRECTOR, ENROLLMENT)
(480) 853-0515
Entity
Organization
Contact information
Practice address
3901 HARRISON AVE, BUTTE, MT 59701-6802
(406) 494-1225
Mailing address
702 SW 8TH STREET, BENTONVILLE, AR 72716-0445
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
744
MT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0214123
—
MT
05
—
1225055569
—
MT
01
—
2051822
PK
—
05
—
214123
—
MT
05
—
5603858
—
MT
Enumeration date
07/16/2006
Last updated
06/11/2025
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