Organization
WALMART INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KIMBERLY CANONIC (SENIOR DIRECTOR, ENROLLMENT)
(480) 277-1242
Entity
Organization
Contact information
Practice address
1959 WALL AVE, OGDEN, UT 84401-0313
(801) 917-2969
Mailing address
702 SW 8TH ST, BENTONVILLE, AR 72716-0445
(479) 277-1242
(479) 277-4331
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
3336C0003X
Community/Retail Pharmacy
Primary
7951137-1703
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2129766
PK
—
Enumeration date
03/31/2011
Last updated
07/08/2025
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