Organization
WALMART INC.
Active
Organization
WALMART INC.
Active
Other names
Walmart Pharmacy 10-3801
Organization subpart
No
Provider details
NPI number
Authorized official
KIMBERLY CANONIC (SENIOR DIRECTOR, ENROLLMENT)
(480) 277-6348
Entity
Organization
Contact information
Practice address
8713 64TH ST NE, MARYSVILLE, WA 98270-7704
(360) 658-9639
(360) 658-9488
Mailing address
702 SW 8TH ST, BENTONVILLE, AR 72716-0445
(479) 277-1242
(479) 277-4331
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
3336C0003X
Community/Retail Pharmacy
Primary
CF.60387625
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2140846
PK
—
Enumeration date
06/06/2013
Last updated
07/08/2025
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