MEDICARE: WALMART INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332B00000X	Durable Medical Equipment & Medical Supplies
2	333600000X	Pharmacy
3	3336C0003X	Community/Retail Pharmacy	Y004091	AZ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1991847	OTHER		PK
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1053338277
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WALMART INC.

Provider Business Mailing Address
First Line	:	702 SW 8TH ST
Second Line	:
City	:	BENTONVILLE
State	:	AR
Zip	:	72716-0445
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	8335 E GUADALUPE RD
Second Line	:
City	:	MESA
State	:	AZ
Zip	:	85212-9630
Country	:	US
Telephone Number	:	480-357-9583
Fax Number	:

Authorized Official
Title or Position	:	SENIOR DIRECTOR, ENROLLMENT
Name	:	KIMBERLY CANONIC
Credential	:
Telephone Number	:	480-853-0515

Provider Enumeration Date	:	07/16/2006
Last Update Date	:	06/13/2025

Similar Medicare Providers

1518911056 — ALLYSON J LAUWERS PHARM-D, RPH
Practice Location Address:

8335 E GUADALUPE RD
MESA, AZ
85212-9630

Practice Phone: 480-357-9583
Practice Fax: 480-357-9781

1942623392 — JAGDISHKUMAR THEKDI
Practice Location Address:

8335 E GUADALUPE RD
MESA, AZ
85212-9630

Practice Phone: 480-357-9583
Practice Fax: 480-357-9781

1669949061 — MR. JESUS JOSE ARROYO JR. RN
Practice Location Address:

10 N MESA CIR
ODESSA, TX
79764-9630

Practice Phone: 432-556-7629
Practice Fax:

1003770918 — ERICA THORNE MSN
Practice Location Address:

11233 E STARFIRE AVE
MESA, AZ
85212-7017

Practice Phone: 623-217-8495
Practice Fax:

1265248751 — FLEX SPINE AND SPORT PHYSICAL THERAPY LLC
Practice Location Address:

7257 S ATWOOD STE 110
MESA, AZ
85212-5510

Practice Phone: 480-571-7282
Practice Fax: 480-852-5990

1467127613 — VALLE DEL SOL, INC.
Practice Location Address:

4135 S POWER RD STE 108
MESA, AZ
85212-3625

Practice Phone: 602-258-6797
Practice Fax:

Directions to “WALMART INC. ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.