Organization
WALMART INC.
Active
Other names
WalMart Pharmacy 10-5396
Organization subpart
No
Provider details
NPI number
Authorized official
KIMBERLY CANONIC (SENIOR DIRECTOR, ENROLLMENT)
(480) 853-0515
Entity
Organization
Contact information
Practice address
1330 GOLDFISH FARM RD SE, ALBANY, OR 97322-5154
(541) 971-4062
Mailing address
702 SW 8TH ST, BENTONVILLE, AR 72716
(479) 277-1238
(479) 277-4331
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
3336C0003X
Community/Retail Pharmacy
Primary
RP0002685
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2132660
PK
—
Enumeration date
11/11/2011
Last updated
06/13/2025
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