Organization
WALMART INC.
Active
Other names
WALMART PHARMACY 10-2325
Organization subpart
No
Provider details
NPI number
Authorized official
KIMBERLY CANONIC (SENIOR DIRECTOR, ENROLLMENT)
(480) 277-6348
Entity
Organization
Contact information
Practice address
3497 BETHEL RD SE, PORT ORCHARD, WA 98366-5634
(360) 874-9063
Mailing address
702 SW 8TH STREET, BENTONVILLE, AR 72716-0445
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
CF0005314
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2110249
PK
—
05
—
6016513
—
WA
Enumeration date
07/16/2006
Last updated
05/27/2025
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