Organization
WALMART INC.
Active
Other names
WALMART PHARMACY 10-3761
Organization subpart
No
Provider details
NPI number
Authorized official
KIMBERLY CANONIC (SENIOR DIRECTOR, ENROLLMENT)
(480) 277-6348
Entity
Organization
Contact information
Practice address
1755 HIGHWAY 59 S, THIEF RIVER FALLS, MN 56701-4317
(218) 683-3655
Mailing address
702 SW 8TH ST, BENTONVILLE, AR 72716-0445
(479) 277-1242
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
262748
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2048636
PK
—
05
—
2627481
—
MN
05
—
88741660
—
MN
05
—
887416600
—
MN
Enumeration date
07/16/2006
Last updated
07/08/2025
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