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NPI 1285965772

NPI 1285965772 : WALMART INC. : KENAI, AK

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General NPI Number Information
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    NPI Number           |    1285965772
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    Entity Type          |    Organization 
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    Legal Business Name  |    WALMART INC. 
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Dates
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    Enumeration Date     |    01/22/2010
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    Last Update Date     |    07/14/2025
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Provider Practice Location Address
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    Address Line         |    10096 KENAI SPUR HWY 
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    City                 |    KENAI
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    State                |    AK
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    Zip                  |    99611-7807
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    Country              |    US
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    Telephone            |    907-395-0871
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    Fax                  |    907-395-4038
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Provider Business Mailing Address
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    Address Line         |    702 SW 8TH ST 
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    City                 |    BENTONVILLE
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    State                |    AR
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    Zip                  |    72716-6209
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    Country              |    US
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    Telephone            |    479-204-8550
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    Fax                  |    479-277-4331
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Authorized Official
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    Title or Position    |    CMS ESMD EMDR
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    Name                 |     KIMBERLY  CANONIC 
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    Credential           |    
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    Telephone            |    480-853-0515
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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    Taxonomy Code        |    3336C0003X
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    Taxonomy Name        |    Community/Retail Pharmacy
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    License Number       |    PHAR470
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    License Number State |    AK
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