Organization
WALMART INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KIMBERLY CANONIC (SENIOR DIRECTOR, ENROLLMENT)
(480) 277-6348
Entity
Organization
Contact information
Practice address
136 W STATE ROAD 73, SARATOGA SPRINGS, UT 84045-2900
(801) 766-0732
Mailing address
702 SW 8TH ST., MAIL STOP 0445, BENTONVILLE, AR 72716-6209
(479) 277-1242
(479) 277-4331
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
7275814-1703
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1699915124
—
UT
01
—
2119372
PK
—
Enumeration date
02/24/2009
Last updated
07/11/2025
Update your record
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