Organization
WALMART INC.
Active
Other names
WalMart Pharmacy 10-5763
Organization subpart
No
Provider details
NPI number
Authorized official
KIMBERLY CANONIC (SENIOR DIRECTOR, ENROLLMENT)
(480) 853-0515
Entity
Organization
Contact information
Practice address
3590 W SOUTH JORDAN PKWY, SOUTH JORDAN, UT 84095-8916
(801) 601-3119
Mailing address
702 SW 8TH ST, BENTONVILLE, AR 72716
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
3336C0003X
Community/Retail Pharmacy
Primary
8528037-1703
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2138832
PK
—
Enumeration date
01/28/2013
Last updated
06/16/2025
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