Organization
WALMART INC.
Active
Other names
WALMART PHARMACY 10-1646
Organization subpart
No
Provider details
NPI number
Authorized official
KIMBERLY CANONIC (SENIOR DIRECTOR, ENROLLMENT)
(480) 853-0515
Entity
Organization
Contact information
Practice address
6131 E SOUTHERN AVE, MESA, AZ 85206-3732
(480) 830-4229
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
Y02323
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
048810
—
AZ
01
—
1989340
PK
—
05
—
48810
—
AZ
Enumeration date
07/19/2006
Last updated
07/09/2025
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