Organization
WALMART INC.
Active
Other names
WalMart Pharmacy 10-4252
Organization subpart
No
Provider details
NPI number
Authorized official
KIMBERLY CANONIC (SENIOR DIRECTOR, ENROLLMENT)
(480) 277-6348
Entity
Organization
Contact information
Practice address
2601 E HUNTINGTON DR, FLAGSTAFF, AZ 86004-8927
(928) 774-3409
Mailing address
702 SW 8TH ST, BENTONVILLE, AR 72716-6209
(479) 277-1242
(479) 277-4331
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
3336C0003X
Community/Retail Pharmacy
Primary
Y005302
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2126719
PK
—
05
—
584908
—
AZ
Enumeration date
09/10/2010
Last updated
07/09/2025
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