Organization
WALMART INC.
Active
Other names
WALMART PHARMACY 10-2121
Organization subpart
No
Provider details
NPI number
Authorized official
KIMBERLY CANONIC (SENIOR DIRECTOR, ENROLLMENT)
(480) 277-6348
Entity
Organization
Contact information
Practice address
100 E WALLACE KNEELAND BLVD, SHELTON, WA 98584-2981
(360) 427-0171
Mailing address
702 SW 8TH STREET, BENTONVILLE, AR 72716-0445
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
CF00004960
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2110100
PK
—
05
—
6014567
—
WA
Enumeration date
07/18/2006
Last updated
06/04/2025
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