Organization
WALMART INC.
Active
Other names
WALMART PHARMACY 10-5494
Organization subpart
No
Provider details
NPI number
Authorized official
KIMBERLY CANONIC (SENIOR DIRECTOR, ENROLLMENT)
(480) 853-0515
Entity
Organization
Contact information
Practice address
500 S UTAH AVE, IDAHO FALLS, ID 83402-3305
(208) 528-8703
(208) 528-8695
Mailing address
702 SW 8TH ST, BENTONVILLE, AR 72716-0445
(479) 204-8550
(479) 277-4331
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
1918RP
ID
3336S0011X
Specialty Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2021893
PK
—
05
—
807089300
—
ID
05
—
807125800
—
ID
Enumeration date
07/16/2006
Last updated
06/16/2025
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