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Organization

WALMART INC.

Active
Other names
WALMART PHARMACY 10-3537
Organization subpart
No

Provider details

NPI number
Authorized official
KIMBERLY CANONIC (SENIOR DIRECTOR, ENROLLMENT)
(480) 853-0515
Entity
Organization

Contact information

Practice address
7001 BRIDGEPORT WAY W, LAKEWOOD, WA 98499-8099
(253) 512-0960
Mailing address
702 SW 8TH STREET, BENTONVILLE, AR 72716-0445
(479) 258-2115

Taxonomy

Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
3336C0003X
Community/Retail Pharmacy
Primary
CF00058916
WA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
2109031
PK
05
6029920
WA
Enumeration date
01/16/2007
Last updated
07/02/2025
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