Organization
WALMART INC.
Active
Other names
WALMART PHARMACY 10-3799
Organization subpart
No
Provider details
NPI number
Authorized official
KIMBERLY CANONIC (SENIOR DIRECTOR, ENROLLMENT)
(480) 277-6348
Entity
Organization
Contact information
Practice address
240 W BASELINE RD, MESA, AZ 85210-6107
(480) 668-9512
Mailing address
702 SW 8TH ST, BENTONVILLE, AR 72716-0445
(479) 277-1242
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
3336C0003X
Community/Retail Pharmacy
Primary
Y004680
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
183560
—
AZ
01
—
1992507
PK
—
Enumeration date
12/27/2006
Last updated
07/08/2025
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