Organization
WALMART INC.
Active
Other names
WalMart Pharmacy 10-1870
Organization subpart
No
Provider details
NPI number
Authorized official
KIMBERLY CANONIC (SENIOR DIRECTOR, ENROLLMENT)
(480) 853-0515
Entity
Organization
Contact information
Practice address
1690 SE HARVEST DR, PULLMAN, WA 99163-6000
(509) 334-2981
(509) 334-2983
Mailing address
702 SW 8TH ST., BENTONVILLE, AR 72716-0445
(479) 277-1238
(479) 277-4331
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
3336C0003X
Community/Retail Pharmacy
Primary
PHAR.CF.60449346
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1649587601
—
ID
05
—
1649587601
—
WA
01
—
2126650
PK
—
Enumeration date
09/10/2010
Last updated
06/12/2025
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