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Organization

WALMART INC.

Active
Other names
Walmart Pharmacy 10-3145
Organization subpart
No

Provider details

NPI number
Authorized official
KIMBERLY CANONIC (SENIOR DIRECTOR, ENROLLMENT)
(480) 277-6348
Entity
Organization

Contact information

Practice address
2201 GRAND BLVD, VANCOUVER, WA 98661-4625
(360) 258-2017
(360) 258-2018
Mailing address
702 SW 8TH ST, BENTONVILLE, AR 72716-0445
(479) 258-2115
(479) 277-4331

Taxonomy

Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
3336C0003X
Community/Retail Pharmacy
Primary
PHAR.CF.60448416
WA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
2035488
WA
01
2144339
PK
Enumeration date
02/10/2014
Last updated
06/06/2025
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