Healthcare Provider Details

I. General information

NPI: 1245258938
Provider Name (Legal Business Name): WALMART INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/18/2006
Last Update Date: 06/13/2025
Certification Date: 06/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1284 W WASHINGTON ST
SEQUIM WA
98382-3227
US

IV. Provider business mailing address

702 SW 8TH STREET
BENTONVILLE AR
72716-0445
US

V. Phone/Fax

Practice location:
  • Phone: 360-683-9453
  • Fax:
Mailing address:
  • Phone: 479-277-1242
  • Fax:

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 TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberCF00058074
License Number StateWA

VII. Legacy identifiers

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

# 1
Identifier6027981
Identifier TypeMEDICAID
Identifier StateWA
Identifier Issuer
# 2
Identifier2108383
Identifier TypeOTHER
Identifier State
Identifier IssuerPK

VIII. Authorized Official

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