Organization
WALMART INC.
Active
Other names
Walmart Pharmacy 10-4203
Organization subpart
No
Provider details
NPI number
Authorized official
KIMBERLY CANONIC (SENIOR DIRECTOR ENROLLMENT)
(480) 853-0515
Entity
Organization
Contact information
Practice address
5210 S HIGHWAY 95, FORT MOHAVE, AZ 86426-9223
(928) 768-9022
(928) 788-3823
Mailing address
702 SW 8TH ST, BENTONVILLE, AR 72716-0445
(479) 258-2115
(479) 277-4331
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
Y007179
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2169017
PK
—
05
—
267651
—
AZ
Enumeration date
02/23/2017
Last updated
07/09/2025
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