Organization
WALMART INC.
Active
Other names
WALMART PHARMACY 10-3754
Organization subpart
No
Provider details
NPI number
Authorized official
KIMBERLY CANONIC (SENIOR DIRECTOR, ENROLLMENT)
(480) 277-6348
Entity
Organization
Contact information
Practice address
108 N APPLE BLOSSOM DR, CHELAN, WA 98816-8679
(509) 682-4634
Mailing address
100 N 6TH ST, #900A, MINNEAPOLIS, MN 55403-1505
(479) 277-1242
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
3336C0003X
Community/Retail Pharmacy
Primary
CF00058936
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2109030
PK
—
05
—
60310401
—
WA
05
—
6031041
—
WA
05
—
6031041DME
—
WA
Enumeration date
12/27/2006
Last updated
07/07/2025
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