Organization
WALMART INC.
Active
Other names
WALMART PHARMACY 10-3531
Organization subpart
No
Provider details
NPI number
Authorized official
KIMBERLY CANONIC (SENIOR DIRECTOR, ENROLLMENT)
(480) 853-0515
Entity
Organization
Contact information
Practice address
1401 GALAXY DR NE, LACEY, WA 98516-4746
(360) 456-7862
Mailing address
702 SW 8TH STREET, BENTONVILLE, AR 72716-0445
(479) 258-2115
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
CF00057370
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2107488
PK
—
05
—
6026173
—
WA
Enumeration date
07/16/2006
Last updated
07/02/2025
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