Organization
WALMART INC.
Active
Other names
Walmart Pharmacy 10-5748
Organization subpart
No
Provider details
NPI number
Authorized official
KIMBERLY CANONIC (SENIOR DIRECTOR, ENROLLMENT)
(480) 853-0515
Entity
Organization
Contact information
Practice address
2150 E 1ST ST, GRIMES, IA 50111-7606
(515) 986-3657
Mailing address
702 SW 8TH ST, BENTONVILLE, AR 72716-6209
(479) 277-1238
(479) 277-4331
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
3336C0003X
Community/Retail Pharmacy
Primary
1377
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2125811
PK
—
Enumeration date
06/29/2010
Last updated
07/08/2025
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