Organization
WALMART INC.
Active
Other names
WALMART PHARMACY 10-3751
Organization subpart
No
Provider details
NPI number
Authorized official
KIMBERLY CANONIC (SENIOR DIRECTOR, ENROLLMENT)
(480) 853-0515
Entity
Organization
Contact information
Practice address
1725 W HUNT HWY, SAN TAN VALLEY, AZ 85143-5203
(480) 677-2540
Mailing address
702 SW 8TH ST, BENTONVILLE, AR 72716-0445
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
Y004393
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
029082
—
AZ
01
—
1992016
PK
—
05
—
4393
—
AZ
Enumeration date
01/03/2007
Last updated
07/08/2025
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