Organization
WALMART INC.
Active
Other names
WALMART PHARMACY 10-5369
Organization subpart
No
Provider details
NPI number
Authorized official
KIMBERLY CANONIC (SENIOR DIRECTOR, ENROLLMENT)
(480) 853-0515
Entity
Organization
Contact information
Practice address
1100 N ESTRELLA PKWY, GOODYEAR, AZ 85338-2808
(623) 925-9883
Mailing address
702 SW 8TH ST, BENTONVILLE, AR 72716-0445
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
Y004296
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1991932
PK
—
05
—
4269
—
AZ
05
—
983165
—
AZ
Enumeration date
01/03/2007
Last updated
06/13/2025
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