Organization
WALMART INC.
Active
Other names
WALMART PHARMACY 10-0980
Organization subpart
No
Provider details
NPI number
Authorized official
KIMBERLY CANONIC (SENIOR DIRECTOR, ENROLLMENT)
(480) 277-6348
Entity
Organization
Contact information
Practice address
3103 S 23RD AVE, GREELEY, CO 80631-8702
(970) 330-4557
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
—
—
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
560000028
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
03015310
—
CO
01
—
2001792
PK
—
05
—
3015310
—
CO
Enumeration date
07/16/2006
Last updated
06/04/2025
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