Organization
WALMART INC.
Active
Other names
Walmart Pharmacy 10-3098
Organization subpart
No
Provider details
NPI number
Authorized official
KIMBERLY CANONIC (SENIOR DIRECTOR, ENROLLMENT)
(480) 277-6348
Entity
Organization
Contact information
Practice address
15063 MAIN ST, BELLEVUE, WA 98007-5225
(425) 643-8015
Mailing address
702 SW 8TH ST, BENTONVILLE, AR 72716
(479) 277-1238
(479) 277-4331
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
3336C0003X
Community/Retail Pharmacy
Primary
PHAR.CF.60287261
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1407113293
—
WA
01
—
2134868
PK
—
Enumeration date
04/18/2012
Last updated
06/05/2025
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