Organization
WALMART INC.
Active
Organization
WALMART INC.
Active
Other names
WalMart Pharmacy 10-3082
Organization subpart
No
Provider details
NPI number
Authorized official
KIMBERLY CANONIC (SENIOR DIRECTOR, ENROLLMENT)
(480) 277-6348
Entity
Organization
Contact information
Practice address
1622 S ACADEMY BLVD, COLORADO SPRINGS, CO 80916-4521
(719) 244-9572
Mailing address
702 SW 8TH ST, BENTONVILLE, AR 72716-0445
(479) 204-0709
(479) 277-4331
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
PDO.1680000018
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
04138562
—
CO
01
—
2138194
PK
—
Enumeration date
11/19/2012
Last updated
06/05/2025
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