Organization
WALMART INC.
Active
Other names
WALMART PHARMACY 10-3382
Organization subpart
No
Provider details
NPI number
Authorized official
KIMBERLY CANONIC (SENIOR DIRECTOR, ENROLLMENT)
(480) 853-0515
Entity
Organization
Contact information
Practice address
78 N MCCULLOCH BLVD, PUEBLO WEST, CO 81007-4444
(719) 647-9925
Mailing address
702 SW 8TH ST, BENTONVILLE, AR 72716-0445
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
653
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2003850
PK
—
05
—
35551020
—
CO
05
—
653
—
CO
Enumeration date
01/03/2007
Last updated
06/19/2025
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