Organization
WALMART INC.
Active
Other names
WALMART PHARMACY 10-0592
Organization subpart
No
Provider details
NPI number
Authorized official
KIMBERLY CANONIC (SENIOR DIRECTOR, ENROLLMENT)
(480) 277-6348
Entity
Organization
Contact information
Practice address
2020 N NELSON DR, DERBY, KS 67037-2572
(316) 788-3731
Mailing address
702 SW 8TH ST, BENTONVILLE, AR 72716-0445
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
2-09752
KS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100432800C
—
KS
05
—
100433010A
—
KS
01
—
2032081
PK
—
05
—
6010831824
—
KS
Enumeration date
07/16/2006
Last updated
06/02/2025
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