Organization
WALMART INC.
Active
Other names
Walmart Pharmacy 10-3739
Organization subpart
No
Provider details
NPI number
Authorized official
KIMBERLY CANONIC (SENIOR DIRECTOR, ENROLLMENT)
(480) 853-0515
Entity
Organization
Contact information
Practice address
5875 E FRANKLIN RD, NAMPA, ID 83687-5020
(208) 461-8718
(208) 461-8720
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
2119RP
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2021943
PK
—
05
—
807635300
—
ID
05
—
907635300
—
ID
Enumeration date
10/03/2006
Last updated
07/08/2025
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