Organization
WALMART INC.
Active
Other names
WalMart Pharmacy 10-4696
Organization subpart
No
Provider details
NPI number
Authorized official
KIMBERLY CANONIC (DIRECTOR OF HEALTHCARE CONTRACTING)
(479) 371-1168
Entity
Organization
Contact information
Practice address
1274 S US HIGHWAY 189, HEBER CITY, UT 84032-5512
(435) 709-3097
Mailing address
1 CUSTOMER DR # MS 0445, BENTONVILLE, AR 72716-0445
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
3336C0003X
Community/Retail Pharmacy
Primary
8044032-1703
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2130770
PK
—
Enumeration date
06/16/2011
Last updated
01/26/2026
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