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NPI Code Detail

MEDICARE: WALMART INC.

MEDICARE: WALMART INC.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1332B00000XDurable Medical Equipment & Medical Supplies
2333600000XPharmacy
33336C0003XCommunity/Retail Pharmacy054009317IL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
12019475OTHERPK

General Provider Information

NPI Number : 1528085891
Entity Type Code : Organization
Provider Name (Legal Business Name) : WALMART INC.
Provider Business Mailing Address
First Line : 702 SW 8TH ST
Second Line :
City : BENTONVILLE
State : AR
Zip : 72716-0445
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 845 BROADMEADOW RD
Second Line :
City : RANTOUL
State : IL
Zip : 61866-2119
Country : US
Telephone Number : 217-892-9171
Fax Number :
Authorized Official
Title or Position : SENIOR DIRECTOR, ENROLLMENT
Name : KIMBERLY CANONIC
Credential :
Telephone Number : 480-277-6348
Provider Enumeration Date : 07/16/2006
Last Update Date : 06/04/2025

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