Organization
WALMART INC.
Active
Other names
WALMART PHARMACY 10-3513
Organization subpart
No
Provider details
NPI number
Authorized official
KIMBERLY CANONIC (SENIOR DIRECTOR, ENROLLMENT)
(480) 853-0515
Entity
Organization
Contact information
Practice address
8101 OLD CARRIAGE CT, SHAKOPEE, MN 55379-3155
(952) 445-8058
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
262258
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2048378
PK
—
05
—
437936500
—
MN
Enumeration date
07/16/2006
Last updated
07/01/2025
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