Organization
WALMART INC.
Active
Other names
WALMART PHARMACY 10-3380
Organization subpart
No
Provider details
NPI number
Authorized official
KIMBERLY CANONIC (SENIOR DIRECTOR, ENROLLMENT)
(480) 853-0515
Entity
Organization
Contact information
Practice address
4820 N ROAD 68, PASCO, WA 99301-9009
(509) 543-7947
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
—
—
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
CF00058475
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2108598
PK
—
05
—
6028872
—
WA
05
—
CF00058475
—
WA
Enumeration date
07/16/2006
Last updated
06/19/2025
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