Organization
WALMART INC.
Active
Other names
WalMart Pharmacy 10-4272
Organization subpart
No
Provider details
NPI number
Authorized official
KIMBERLY CANONIC (SENIOR DIRECTOR, ENROLLMENT)
(480) 277-6348
Entity
Organization
Contact information
Practice address
1150 S 100 W, LOGAN, UT 84321-5573
(435) 787-4143
Mailing address
702 SW 8TH ST, MAIL STOP 0445, BENTONVILLE, AR 72716-0445
(479) 277-1242
(479) 277-4331
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
3336C0003X
Community/Retail Pharmacy
Primary
7316392-1703
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2119984
PK
—
Enumeration date
04/08/2009
Last updated
07/09/2025
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