Organization
WALMART INC.
Active
Other names
WalMart Pharmacy 10-3173
Organization subpart
No
Provider details
NPI number
Authorized official
KIMBERLY CANONIC (SENIOR DIRECTOR, ENROLLMENT)
(480) 277-6348
Entity
Organization
Contact information
Practice address
9460 GILES RD, LA VISTA, NE 68128-3064
(402) 513-4214
Mailing address
702 SW 8TH STREET, BENTONVILLE, AR 72716-0445
(479) 204-8550
(473) 277-4331
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
3006
NE
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2141863
PK
—
Enumeration date
08/28/2013
Last updated
06/06/2025
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