Organization
WALMART INC.
Active
Other names
WALMART PHARMACY 10-5269
Organization subpart
No
Provider details
NPI number
Authorized official
KIMBERLY CANONIC (SENIOR DIRECTOR, ENROLLMENT)
(480) 853-0515
Entity
Organization
Contact information
Practice address
490 E SILVERADO RANCH BLVD, LAS VEGAS, NV 89183-6290
(702) 263-4270
Mailing address
702 SW 8TH STREET, BENTONVILLE, AR 72716-0445
(479) 277-1242
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
PH01985
NV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100505343
—
NV
01
—
2051671
PK
—
Enumeration date
07/19/2006
Last updated
06/13/2025
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