Organization
WALMART INC.
Active
Other names
Walmart Pharmacy 10-3150
Organization subpart
No
Provider details
NPI number
Authorized official
KIMBERLY CANONIC (SENIOR DIRECTOR, ENROLLMENT)
(480) 277-6348
Entity
Organization
Contact information
Practice address
1800 N 16TH ST, COUNCIL BLUFFS, IA 51501-0123
(712) 890-3915
(712) 890-3919
Mailing address
702 SW 8TH ST, BENTONVILLE, AR 72716-0445
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
3336C0003X
Community/Retail Pharmacy
Primary
1517
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2148714
PK
—
Enumeration date
07/11/2014
Last updated
06/05/2025
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