Organization
WALMART INC.
Active
Other names
WALMART PHARMACY 10-3351
Organization subpart
No
Provider details
NPI number
Authorized official
KIMBERLY CANONIC (SENIOR DIRECTOR, ENROLLMENT)
(480) 853-0515
Entity
Organization
Contact information
Practice address
6464 N DECATUR BLVD, LAS VEGAS, NV 89131-2959
(702) 515-7181
(702) 515-7182
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
PH02186
NV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100511256
—
NV
05
—
1235223397
—
NV
01
—
2052198
PK
—
Enumeration date
10/03/2006
Last updated
06/19/2025
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