Organization
WALMART INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KIMBERLY CANONIC (SENIOR DIRECTOR, ENROLLMENT)
(480) 277-6348
Entity
Organization
Contact information
Practice address
16241 S FARRELL RD, LOCKPORT, IL 60441-8101
(815) 836-3422
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
—
—
3336C0003X
Community/Retail Pharmacy
Primary
054016292
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2023597
PK
—
Enumeration date
07/13/2007
Last updated
07/08/2025
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