Healthcare Provider Details

I. General information

NPI: 1164772604
Provider Name (Legal Business Name): WALMART INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/12/2012
Last Update Date: 09/19/2025
Certification Date: 08/30/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6005 MADISON AVE
CARMICHAEL CA
95608-0521
US

IV. Provider business mailing address

702 SW 8TH ST
BENTONVILLE AR
72716-6209
US

V. Phone/Fax

Practice location:
  • Phone: 916-534-1162
  • Fax: 916-534-1158
Mailing address:
  • Phone: 479-277-1238
  • Fax: 479-277-4331

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPHY51104
License Number StateCA

VIII. Authorized Official

Name: SARAH LITTLE
Title or Position: DIRECTOR OF HEALTHCARE CONTRACTING
Credential:
Phone: 479-277-2500