Organization
WALMART INC.
Active
Other names
WalMart Pharmacy 10-4288
Organization subpart
No
Provider details
NPI number
Authorized official
KIMBERLY CANONIC (SENIOR DIRECTOR, ENROLLMENT)
(480) 277-6348
Entity
Organization
Contact information
Practice address
4651 W 121ST AVE, BROOMFIELD, CO 80020-5662
(720) 887-8453
Mailing address
702 SW 8TH ST, MAIL STOP 0445, 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
798
CO
3336S0011X
Specialty Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
10485350
—
CO
01
—
2124534
PK
—
Enumeration date
04/05/2010
Last updated
07/09/2025
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