Organization
WALMART INC.
Active
Other names
WALMART PHARMACY 10-3408
Organization subpart
No
Provider details
NPI number
Authorized official
KIMBERLY CANONIC (SENIOR DIRECTOR, ENROLLMENT)
(480) 853-0515
Entity
Organization
Contact information
Practice address
3200 MARKET ST, CARSON CITY, NV 89706-7984
(775) 883-6535
Mailing address
702 SW 8TH STREET, BENTONVILLE, AR 72716-0445
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
PH02072
NV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100507670
—
NV
01
—
2052112
PK
—
05
—
PH02072
—
NV
Enumeration date
07/16/2006
Last updated
06/19/2025
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