Organization
WALMART INC.
Active
Organization
WALMART INC.
Active
Other names
WalMart Pharmacy 10-5429
Organization subpart
No
Provider details
NPI number
Authorized official
KIMBERLY CANONIC (SENIOR DIRECTOR, ENROLLMENT)
(480) 853-0515
Entity
Organization
Contact information
Practice address
14111 N PRASADA GATEWAY AVE, SURPRISE, AZ 85388-2201
(623) 282-3215
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
—
—
3336C0003X
Community/Retail Pharmacy
Primary
Y005454
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2133816
PK
—
05
—
714424
—
AZ
Enumeration date
02/10/2012
Last updated
06/16/2025
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