Organization
WALMART INC.
Active
Other names
WALMART PHARMACY 10-4253
Organization subpart
No
Provider details
NPI number
Authorized official
KIMBERLY CANONIC (SENIOR DIRECTOR, ENROLLMENT)
(480) 277-6348
Entity
Organization
Contact information
Practice address
205 12TH ST S, SAUK CENTRE, MN 56378-1614
(320) 352-7943
Mailing address
702 SW 8TH ST, BENTONVILLE, AR 72716-0445
(479) 277-1242
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
3336C0003X
Community/Retail Pharmacy
Primary
263005
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2049225
PK
—
05
—
907630000
—
MN
Enumeration date
03/19/2007
Last updated
07/09/2025
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