Organization
WALMART INC.
Active
Other names
WALMART PHARMACY 10-5306
Organization subpart
No
Provider details
NPI number
Authorized official
KIMBERLY CANONIC (SENIOR DIRECTOR, ENROLLMENT)
(480) 853-0515
Entity
Organization
Contact information
Practice address
5545 SIMMONS ST, NORTH LAS VEGAS, NV 89031-9005
(702) 646-2650
(702) 646-2495
Mailing address
702 SW 8TH STREET, BENTONVILLE, AR 72716-0445
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
PH01986
NV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100505511
—
NV
05
—
1881611994
—
NV
01
—
2051672
PK
—
Enumeration date
07/16/2006
Last updated
06/13/2025
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