Healthcare Provider Details

I. General information

NPI: 1336916980
Provider Name (Legal Business Name): WALMART, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/05/2023
Last Update Date: 06/24/2024
Certification Date: 06/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1741 E FLORENCE BLVD
CASA GRANDE AZ
85122-4763
US

IV. Provider business mailing address

702 SW 8TH ST
BENTONVILLE AR
72716-0445
US

V. Phone/Fax

Practice location:
  • Phone: 520-836-3357
  • Fax: 520-836-7531
Mailing address:
  • Phone: 479-258-2115
  • Fax: 479-277-4331

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code156FX1800X
TaxonomyOptician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License Number
License Number State

VIII. Authorized Official

Name: MATTHEW MCMULLIN
Title or Position: DIRECTOR
Credential:
Phone: 479-371-8711