Organization
WALMART INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KIMBERLY CANONIC (SENIOR DIRECTOR, ENROLLMENT)
(480) 853-0515
Entity
Organization
Contact information
Practice address
1275 LAKE AVE, WOODSTOCK, IL 60098-7415
(815) 206-0938
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
054016089
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2023280
PK
—
Enumeration date
12/27/2006
Last updated
06/19/2025
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