Organization
WALMART INC.
Active
Other names
WalMart Pharmacy 10-3154
Organization subpart
No
Provider details
NPI number
Authorized official
KIMBERLY CANONIC (SENIOR DIRECTOR, ENROLLMENT)
(480) 277-6348
Entity
Organization
Contact information
Practice address
2109 TOWNE CENTER DR, BELLEVUE, NE 68123-6404
(402) 686-2043
(402) 292-0060
Mailing address
702 SW 8TH ST, BENTONVILLE, AR 72716-0445
(479) 204-8741
(479) 277-4331
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
2960
NE
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100262714-00
—
NE
01
—
2138826
PK
—
Enumeration date
01/31/2013
Last updated
06/06/2025
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