Organization
WALMART INC.
Active
Other names
WALMART PHARMACY 10-5440
Organization subpart
No
Provider details
NPI number
Authorized official
KIMBERLY CANONIC (SENIOR DIRECTOR, ENROLLMENT)
(480) 853-0515
Entity
Organization
Contact information
Practice address
10000 SE 82ND AVE, HAPPY VALLEY, OR 97086-2304
(503) 788-4757
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
0002245CS
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2079344
PK
—
05
—
274798
—
OR
05
—
277990
—
OR
Enumeration date
07/19/2006
Last updated
06/13/2025
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