Organization
WALMART INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KIMBERLY CANONIC (SENIOR DIRECTOR, ENROLLMENT)
(480) 853-0515
Entity
Organization
Contact information
Practice address
100 S HIGH CROSS RD, URBANA, IL 61802-7804
(217) 344-6190
Mailing address
702 SW 8TH ST, BENTONVILLE, AR 72716-0445
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
054015756
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2021841
PK
—
05
—
54001576
—
IL
Enumeration date
07/16/2006
Last updated
06/13/2025
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