Organization
WALMART INC.
Active
Other names
Walmart Pharmacy 10-2006
Organization subpart
No
Provider details
NPI number
Authorized official
KIMBERLY CANONIC (SENIOR DIRECTOR, ENROLLMENT)
(480) 277-6348
Entity
Organization
Contact information
Practice address
306 5TH ST, CLARKSTON, WA 99403-1860
(509) 758-6660
Mailing address
702 SW 8TH ST, BENTONVILLE, AR 72716-0445
(479) 277-1238
(479) 277-4331
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
3336C0003X
Community/Retail Pharmacy
Primary
CF.60099303
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1396977203
—
WA
01
—
2121485
PK
—
Enumeration date
08/12/2009
Last updated
06/06/2025
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