Organization
WALMART INC.
Active
Other names
WalMart Pharmacy 10-4208
Organization subpart
No
Provider details
NPI number
Authorized official
KIMBERLY CANONIC (SENIOR DIRECTOR ENROLLMENT)
(480) 853-0515
Entity
Organization
Contact information
Practice address
2705 E PARLEYS WAY, SALT LAKE CITY, UT 84109-1619
(385) 313-3949
Mailing address
702 SW 8TH ST, BENTONVILLE, AR 72716
(479) 277-1238
(479) 277-4331
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
3336C0003X
Community/Retail Pharmacy
Primary
8434780-1703
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1326396300
—
UT
01
—
2136650
PK
—
Enumeration date
08/22/2012
Last updated
07/09/2025
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