Organization
WALMART INC.
Active
Other names
WALMART PHARMACY 10-2367
Organization subpart
No
Provider details
NPI number
Authorized official
KIMBERLY CANONIC (SENIOR DIRECTOR, ENROLLMENT)
(480) 277-6348
Entity
Organization
Contact information
Practice address
950 11TH ST SW, PINE CITY, MN 55063-2113
(320) 629-6225
Mailing address
702 SW 8TH ST, BENTONVILLE, AR 72716-0445
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
2614779
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
073825500
—
MN
01
—
2047826
PK
—
05
—
73825500
—
MN
Enumeration date
07/16/2006
Last updated
05/30/2025
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