Organization
WALMART INC.
Active
Other names
Walmart Pharmacy 10-3103
Organization subpart
No
Provider details
NPI number
Authorized official
KIMBERLY CANONIC (SENIOR DIRECTOR, ENROLLMENT)
(480) 277-6348
Entity
Organization
Contact information
Practice address
18631 W KELLOGG DR, GODDARD, KS 67052-9221
(316) 794-2703
(316) 347-2099
Mailing address
702 SW 8TH ST, BENTONVILLE, AR 72716-0445
(479) 204-8550
(479) 277-4331
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
3336C0003X
Community/Retail Pharmacy
Primary
210430
KS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2137629
PK
—
Enumeration date
10/30/2012
Last updated
06/05/2025
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