Organization
WALMART INC.
Active
Other names
WALMART PHARMACY 10-4339
Organization subpart
No
Provider details
NPI number
Authorized official
KIMBERLY CANONIC (SENIOR DIRECTOR, ENROLLMENT)
(480) 853-0515
Entity
Organization
Contact information
Practice address
5940 LOSEE RD, N LAS VEGAS, NV 89081-6591
(702) 639-9002
(702) 639-9009
Mailing address
702 SW 8TH STREET, BENTONVILLE, AR 72716-0445
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
3336C0003X
Community/Retail Pharmacy
Primary
PH02285
NV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1902006778
—
NV
01
—
2052253
PK
—
Enumeration date
07/20/2007
Last updated
07/09/2025
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