Organization
WALMART INC.
Active
Other names
WALMART PHARMACY 10-4321
Organization subpart
No
Provider details
NPI number
Authorized official
KIMBERLY CANONIC (SENIOR DIRECTOR, ENROLLMENT)
(480) 853-0515
Entity
Organization
Contact information
Practice address
5475 N MERIDIAN AVE, WICHITA, KS 67204-1620
(316) 831-9057
Mailing address
702 SW 8TH ST, BENTONVILLE, AR 72716-0445
(479) 204-8550
(479) 277-4331
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
3336C0003X
Community/Retail Pharmacy
Primary
210169
KS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100432800N
—
KS
01
—
2027825
PK
—
Enumeration date
12/05/2007
Last updated
07/08/2025
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