Healthcare Provider Details

I. General information

NPI: 1649587601
Provider Name (Legal Business Name): WALMART INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/10/2010
Last Update Date: 06/12/2025
Certification Date: 06/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1690 SE HARVEST DR
PULLMAN WA
99163-6000
US

IV. Provider business mailing address

702 SW 8TH ST.
BENTONVILLE AR
72716-0445
US

V. Phone/Fax

Practice location:
  • Phone: 509-334-2981
  • Fax: 509-334-2983
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 NumberPHAR.CF.60449346
License Number StateWA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier1649587601
Identifier TypeMEDICAID
Identifier StateID
Identifier Issuer
# 2
Identifier1649587601
Identifier TypeMEDICAID
Identifier StateWA
Identifier Issuer
# 3
Identifier2126650
Identifier TypeOTHER
Identifier State
Identifier IssuerPK

VIII. Authorized Official

Name: KIMBERLY CANONIC
Title or Position: SENIOR DIRECTOR, ENROLLMENT
Credential:
Phone: 480-853-0515