Organization
WALMART INC.
Active
Other names
WALMART PHARMACY 10-5304
Organization subpart
No
Provider details
NPI number
Authorized official
KIMBERLY CANONIC (SENIOR DIRECTOR, ENROLLMENT)
(480) 853-0515
Entity
Organization
Contact information
Practice address
1916 S LINDSAY RD, MESA, AZ 85204-7108
(480) 892-6772
Mailing address
702 SW 8TH ST, BENTONVILLE, AR 72716-6209
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
Y004003
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1991832
PK
—
05
—
867236
—
AZ
Enumeration date
07/19/2006
Last updated
06/13/2025
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