Organization
WALMART INC.
Active
Other names
WALMART PHARMACY 10-5190
Organization subpart
No
Provider details
NPI number
Authorized official
KIMBERLY CANONIC (SENIOR DIRECTOR, ENROLLMENT)
(480) 853-0515
Entity
Organization
Contact information
Practice address
2501 W HAPPY VALLEY RD STE 34, STE 34, PHOENIX, AZ 85085-3712
(623) 780-5713
Mailing address
702 SW 8TH ST, BENTONVILLE, AR 72716-6209
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
Y04198
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1991880
PK
—
05
—
917445
—
AZ
Enumeration date
07/16/2006
Last updated
06/12/2025
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