Organization
WALMART INC.
Active
Other names
Walmart Pharmacy 10-5737
Organization subpart
No
Provider details
NPI number
Authorized official
KIMBERLY CANONIC (SENIOR DIRECTOR, ENROLLMENT)
(480) 853-0515
Entity
Organization
Contact information
Practice address
3475 BLACK FOREST DR, FAYETTEVILLE, AR 72704-6524
(479) 442-2276
(479) 444-6866
Mailing address
702 SW 8TH ST, BENTONVILLE, AR 72716-6209
(479) 277-1238
(479) 277-4331
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
AR20651
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
188051407
—
AR
01
—
2129772
PK
—
Enumeration date
03/31/2011
Last updated
07/08/2025
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