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
1	332B00000X	Durable Medical Equipment & Medical Supplies
2	333600000X	Pharmacy
3	3336C0003X	Community/Retail Pharmacy	1334941703	UT

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2099840	OTHER		PK

General Provider Information

NPI Number	:	1861419053
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	:	6545 N LANDMARK DR
Second Line	:
City	:	PARK CITY
State	:	UT
Zip	:	84098-5990
Country	:	US
Telephone Number	:	435-647-9040
Fax Number	:

Authorized Official
Title or Position	:	SENIOR DIRECTOR, ENROLLMENT
Name	:	KIMBERLY CANONIC
Credential	:
Telephone Number	:	480-853-0515

Provider Enumeration Date	:	07/16/2006
Last Update Date	:	06/16/2025

Similar Medicare Providers

1124620521 — HEATH LAMOREAUX
Practice Location Address:

6545 N LANDMARK DR
PARK CITY, UT
84098-5990

Practice Phone: 435-647-9050
Practice Fax: 435-647-9042

1417559451 — NINA IVANOVA
Practice Location Address:

6545 N LANDMARK DR
PARK CITY, UT
84098-5990

Practice Phone: 435-647-9040
Practice Fax: 435-647-9042

1447277728 — WALMART INC.
Practice Location Address:

5990 DAHLIA ST
COMMERCE CITY, CO
80022-3708

Practice Phone: 303-287-0909
Practice Fax:

1265517841 — WALMART INC.
Practice Location Address:

5990 DAHLIA ST
COMMERCE CITY, CO
80022-3708

Practice Phone: 303-287-0600
Practice Fax:

1467599977 — DIEGO ALEXANDER POSADA O.D.
Practice Location Address:

5990 DAHLIA ST , SUITE A
COMMERCE CITY, CO
80022-3708

Practice Phone: 303-287-2777
Practice Fax:

1144439175 — HOOD & HOOD DC PA
Practice Location Address:

5990 54TH AVE N
KENNETH CITY, FL
33709-1804

Practice Phone: 727-544-9000
Practice Fax: 727-544-9013

Directions to “WALMART INC. ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.