Organization
WALMART INC.
Active
Other names
WalMart Pharmacy 10-4747
Organization subpart
No
Provider details
NPI number
Authorized official
KIMBERLY CANONIC (SENIOR DIRECTOR, ENROLLMENT)
(480) 277-6348
Entity
Organization
Contact information
Practice address
10755 WASHINGTON ST, NORTHGLENN, CO 80233-3438
(303) 200-1492
Mailing address
702 SW 8TH ST, BENTONVILLE, AR 72716-0445
(479) 258-2115
(479) 277-4331
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
3336C0003X
Community/Retail Pharmacy
Primary
PDO.1680000061
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2145086
PK
—
05
—
74631764
—
CO
Enumeration date
04/03/2014
Last updated
06/06/2025
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