Organization
WALMART INC.
Active
Other names
WALMART PHARMACY 10-3845
Organization subpart
No
Provider details
NPI number
Authorized official
KIMBERLY CANONIC (SENIOR DIRECTOR ENROLLMENT)
(480) 853-0515
Entity
Organization
Contact information
Practice address
6645 W PEORIA AVE, GLENDALE, AZ 85302-1011
(623) 773-2954
Mailing address
702 SW 8TH ST, BENTONVILLE, AR 72716-0445
(479) 204-8550
(479) 277-4331
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
3336C0003X
Community/Retail Pharmacy
Primary
Y004888
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1992588
PK
—
Enumeration date
07/23/2007
Last updated
07/08/2025
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