Organization
WALMART INC.
Active
Other names
WALMART PHARMACY 10-1925
Organization subpart
No
Provider details
NPI number
Authorized official
KIMBERLY CANONIC (SENIOR DIRECTOR, ENROLLMENT)
(480) 277-6348
Entity
Organization
Contact information
Practice address
160 NW 25TH ST, NEWPORT, OR 97365-1637
(541) 265-6076
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
0001272CS
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
052881
—
OR
01
—
2078282
PK
—
05
—
52881
—
OR
Enumeration date
07/16/2006
Last updated
06/10/2025
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