Organization
WALMART INC.
Active
Other names
WALMART PHARMACY 10-1001
Organization subpart
No
Provider details
NPI number
Authorized official
KIMBERLY CANONIC (SENIOR DIRECTOR, ENROLLMENT)
(480) 277-6348
Entity
Organization
Contact information
Practice address
4080 W NORTHERN AVE, PUEBLO, CO 81005-3503
(719) 561-0951
Mailing address
702 SW 8TH ST, 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
1040000048
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
03015450
—
CO
01
—
2001797
PK
—
05
—
315450
—
CO
Enumeration date
07/16/2006
Last updated
06/05/2025
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