Organization
WALMART INC.
Active
Other names
WAL-MART PHARMACY 10-1772
Organization subpart
No
Provider details
NPI number
Authorized official
KIMBERLY CANONIC (SENIOR DIRECTOR, ENROLLMENT)
(480) 853-0515
Entity
Organization
Contact information
Practice address
3600 WASHBURN WAY, KLAMATH FALLS, OR 97603-4539
(541) 885-6968
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
0001211CS
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
038765
—
OR
05
—
1780601823
—
CA
05
—
186714
—
OR
01
—
2078249
PK
—
05
—
38765
—
OR
Enumeration date
07/16/2006
Last updated
06/17/2025
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