Organization
WALMART, INC.
Active
Other names
Walmart pharmacy 10-3164
Organization subpart
No
Provider details
NPI number
Authorized official
KIMBERLY CANONIC (SR DIRECTOR)
(479) 371-1168
Entity
Organization
Contact information
Practice address
2770 CARSON ST, LAKEWOOD, CA 90712-4004
(562) 497-1517
(562) 425-4577
Mailing address
1 CUSTOMER DR, MS 0445, BENTONVILLE, AR 72716-0445
Taxonomy
Speciality
Code
Description
License number
State
156FX1800X
Optician
Primary
—
—
332H00000X
Eyewear Supplier
—
—
Other
Enumeration date
12/08/2023
Last updated
10/02/2025
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