Organization
WALMART INC.
Active
Other names
WalMart Pharmacy 10-4178
Organization subpart
No
Provider details
NPI number
Authorized official
KIMBERLY CANONIC (SENIOR DIRECTOR, ENROLLMENT)
(480) 277-6348
Entity
Organization
Contact information
Practice address
2730 GATEWAY ST, SPRINGFIELD, OR 97477-7705
(541) 632-7094
(541) 632-7088
Mailing address
702 SW 8TH ST, BENTONVILLE, AR 72716-0445
(479) 204-8550
(479) 277-4331
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
3336C0003X
Community/Retail Pharmacy
Primary
RP-0002816-CS
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2141552
PK
—
Enumeration date
08/07/2013
Last updated
06/06/2025
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