Organization
WALMART INC.
Active
Other names
WalMart Pharmacy 10-3730
Organization subpart
No
Provider details
NPI number
Authorized official
KIMBERLY CANONIC (SENIOR DIRECTOR, ENROLLMENT)
(480) 853-0515
Entity
Organization
Contact information
Practice address
3450 N GLASSFORD HILL RD, PRESCOTT VALLEY, AZ 86314-1351
(928) 499-3478
Mailing address
702 SW 8TH ST, BENTONVILLE, AR 72716-0445
(479) 273-4885
(479) 277-4331
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
3336C0003X
Community/Retail Pharmacy
Primary
Y005763
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2142254
PK
—
05
—
861349
—
AZ
Enumeration date
08/20/2013
Last updated
07/08/2025
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