Organization
WALMART INC.
Active
Other names
WALMART PHARMACY 10-4377
Organization subpart
No
Provider details
NPI number
Authorized official
KIMBERLY CANONIC (SENIOR DIRECTOR, ENROLLMENT)
(480) 853-0515
Entity
Organization
Contact information
Practice address
2000 W VICTORY WAY, CRAIG, CO 81625-3440
(970) 824-0317
Mailing address
702 SW 8TH ST, BENTONVILLE, AR 72716-0445
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
3336C0003X
Community/Retail Pharmacy
Primary
709
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
09584013
—
CO
05
—
126531800
—
WY
01
—
1997767
PK
—
Enumeration date
07/20/2007
Last updated
07/10/2025
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