Organization
WALMART INC.
Active
Other names
WalMart Pharmacy 10-7168
Organization subpart
No
Provider details
NPI number
Authorized official
KIMBERLY CANONIC (SENIOR DIRECTOR, ENROLLMENT)
(480) 277-6348
Entity
Organization
Contact information
Practice address
5056 W 13400 S, HERRIMAN, UT 84096-6600
(801) 981-1680
(801) 981-1677
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
9206148-1703
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1417352600
—
UT
01
—
2148706
PK
—
Enumeration date
10/30/2014
Last updated
06/06/2025
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