Organization
WALMART INC.
Active
Organization
WALMART INC.
Active
Other names
WALMART PHARMACY 10-1778
Organization subpart
No
Provider details
NPI number
Authorized official
KIMBERLY CANONIC (SENIOR DIRECTOR, ENROLLMENT)
(480) 853-0515
Entity
Organization
Contact information
Practice address
321 YELLOWSTONE AVE, CODY, WY 82414-9315
(307) 527-5746
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
5202774
WY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
105593300 CON
—
WY
05
—
105593300CON
—
WY
01
—
2111468
PK
—
Enumeration date
07/16/2006
Last updated
06/17/2025
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