Organization
WALMART INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KIMBERLY CANONIC (SENIOR DIRECTOR, ENROLLMENT)
(480) 277-6348
Entity
Organization
Contact information
Practice address
2100 HIGHWAY 77, MARION, AR 72364
(870) 394-7305
(870) 394-7304
Mailing address
702 SW 8TH ST, MAILSTOP 0445, BENTONVILLE, AR 72716-0445
(479) 204-1258
(479) 277-4331
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
3336C0003X
Community/Retail Pharmacy
Primary
AR20823
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
211263407
—
AR
01
—
2154960
PK
—
Enumeration date
10/26/2015
Last updated
06/10/2025
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