Organization
WALMART INC.
Active
Other names
Walmart Pharmacy 10-3053
Organization subpart
No
Provider details
NPI number
Authorized official
KIMBERLY CANONIC (SENIOR DIRECTOR, ENROLLMENT)
(480) 277-6348
Entity
Organization
Contact information
Practice address
1605 SE EVERETT MALL WAY, EVERETT, WA 98208-2838
(425) 789-3364
(425) 789-3365
Mailing address
702 SW 8TH ST, BENTONVILLE, AR 72716-0445
(479) 258-2115
(479) 277-4331
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
3336C0003X
Community/Retail Pharmacy
Primary
PHAR.CF.60476147
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2038070
—
WA
01
—
2146269
PK
—
Enumeration date
06/10/2014
Last updated
06/05/2025
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