Organization
WALMART INC.
Active
Other names
WalMart Pharmacy 10-3883
Organization subpart
No
Provider details
NPI number
Authorized official
KIMBERLY CANONIC (SENIOR DIRECTOR, ENROLLMENT)
(480) 853-0515
Entity
Organization
Contact information
Practice address
91-600 FARRINGTON HWY, KAPOLEI, HI 96707-4511
(808) 206-9415
Mailing address
702 SW 8TH ST, BENTONVILLE, AR 72716-6209
(479) 277-1238
(479) 277-4331
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
PHY-810
HI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1568733178
—
HI
01
—
2133635
PK
—
Enumeration date
01/13/2012
Last updated
07/08/2025
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