Organization
WALMART INC.
Active
Other names
WALMART PHARMACY 10-1562
Organization subpart
No
Provider details
NPI number
Authorized official
KIMBERLY CANONIC (SENIOR DIRECTOR, ENROLLMENT)
(480) 277-6348
Entity
Organization
Contact information
Practice address
13020 RIVERDALE DR NW, COON RAPIDS, MN 55448-1057
(763) 421-5717
Mailing address
702 SW 8TH ST, MAIL STOP 0445, BENTONVILLE, AR 72716-0445
(479) 277-1242
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
260734
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2046715
PK
—
05
—
776560600
—
MN
Enumeration date
07/16/2006
Last updated
07/11/2025
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