Organization
WALMART INC.
Active
Other names
Walmart Pharmacy 10-4221
Organization subpart
No
Provider details
NPI number
Authorized official
KIMBERLY CANONIC (SENIOR DIRECTOR ENROLLMENT)
(479) 371-1168
Entity
Organization
Contact information
Practice address
220 N ADAIR ST, CORNELIUS, OR 97113-8404
(503) 207-0635
Mailing address
702 SW 8TH ST., BENTONVILLE, AR 72716-6209
(479) 277-1238
(479) 277-4331
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
3336C0003X
Community/Retail Pharmacy
Primary
RP-0002612-CS
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2125806
PK
—
05
—
500632409
—
OR
Enumeration date
06/28/2010
Last updated
07/09/2025
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