Organization
WALMART INC.
Active
Other names
WalMart Pharmacy 10-3844
Organization subpart
No
Provider details
NPI number
Authorized official
KIMBERLY CANONIC (SENIOR DIRECTOR ENROLLMENT)
(480) 853-0515
Entity
Organization
Contact information
Practice address
5137 W OLIVE AVE, GLENDALE, AZ 85302-4204
(623) 939-4252
Mailing address
702 SW 8TH ST, BENTONVILLE, AR 72716-6209
(479) 277-1238
(479) 277-4331
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
3336C0003X
Community/Retail Pharmacy
Primary
Y005325
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2127444
PK
—
05
—
588160
—
AZ
Enumeration date
10/28/2010
Last updated
07/08/2025
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