Organization
WALMART INC.
Active
Other names
WalMart Pharmacy 10-3511
Organization subpart
No
Provider details
NPI number
Authorized official
KIMBERLY CANONIC (SENIOR DIRECTOR, ENROLLMENT)
(480) 853-0515
Entity
Organization
Contact information
Practice address
550 W HONEYSUCKLE AVE, HAYDEN, ID 83835-6042
(208) 209-4081
(208) 209-4057
Mailing address
702 SW 8TH ST, BENTONVILLE, AR 72716-0445
(479) 204-8550
(479) 277-4331
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
3336C0003X
Community/Retail Pharmacy
Primary
14644RP
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2126071
PK
—
Enumeration date
07/30/2010
Last updated
07/01/2025
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