Organization
WALMART INC.
Active
Organization
WALMART INC.
Active
Other names
WALMART PHARMACY 10-5423
Organization subpart
No
Provider details
NPI number
Authorized official
KIMBERLY CANONIC (SENIOR DIRECTOR, ENROLLMENT)
(480) 853-0515
Entity
Organization
Contact information
Practice address
6570 E LAKE MEAD BLVD, LAS VEGAS, NV 89156-7044
(702) 437-2554
Mailing address
702 SW 8TH STREET, BENTONVILLE, AR 72716-0445
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
PH02078
NV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
10050788
—
NV
05
—
100507888
—
NV
01
—
2052111
PK
—
Enumeration date
04/24/2007
Last updated
06/16/2025
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