Organization
WALMART INC.
Active
Other names
WALMART PHARMACY 10-1617
Organization subpart
No
Provider details
NPI number
Authorized official
KIMBERLY CANONIC (SENIOR DIRECTOR, ENROLLMENT)
(480) 853-0515
Entity
Organization
Contact information
Practice address
4400 E 2ND ST, CASPER, WY 82609-4221
(307) 237-0994
Mailing address
702 SW 8TH STREET, BENTONVILLE, AR 72716-0445
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
5202736
WY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
105602600 CON
—
WY
05
—
105602600CON
—
WY
01
—
2111464
PK
—
Enumeration date
07/16/2006
Last updated
07/11/2025
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