Healthcare Provider Details

I. General information

NPI: 1659796936
Provider Name (Legal Business Name): WALMART INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/24/2014
Last Update Date: 09/19/2025
Certification Date: 08/30/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20226 AVALON BLVD
CARSON CA
90746-3829
US

IV. Provider business mailing address

702 SW 8TH ST
BENTONVILLE AR
72716-0445
US

V. Phone/Fax

Practice location:
  • Phone: 424-233-3319
  • Fax: 424-233-3320
Mailing address:
  • Phone: 479-273-4885
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number51774
License Number StateCA

VIII. Authorized Official

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