Organization
WALMART INC.
Active
Other names
WalMart Pharmacy 10-3176
Organization subpart
No
Provider details
NPI number
Authorized official
KIMBERLY CANONIC (SENIOR DIRECTOR, ENROLLMENT)
(480) 277-6348
Entity
Organization
Contact information
Practice address
1725 N UNION BLVD, COLORADO SPRINGS, CO 80909-2850
(719) 473-8250
(719) 473-6070
Mailing address
702 SW 8TH ST, BENTONVILLE, AR 72716-0445
(479) 204-8741
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
3336C0003X
Community/Retail Pharmacy
Primary
PDO.1680000035
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2140837
PK
—
Enumeration date
06/06/2013
Last updated
06/05/2025
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