Organization
WALMART INC.
Active
Other names
Walmart Pharmacy 10-3988
Organization subpart
No
Provider details
NPI number
Authorized official
KIMBERLY CANONIC (SENIOR DIRECTOR, ENROLLMENT)
(480) 853-0515
Entity
Organization
Contact information
Practice address
898 S 2550 E, SPANISH FORK, UT 84660
(801) 504-9613
(801) 504-9614
Mailing address
702 SW 8TH ST, BENTONVILLE, AR 72716-0445
(479) 258-2115
(479) 277-4331
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
1047968-1703
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2170204
PK
—
05
—
3004593
—
UT
Enumeration date
05/04/2017
Last updated
06/11/2025
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