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	3336C0003X	Community/Retail Pharmacy	PH02226	NV

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	2052225	OTHER		PK

General Provider Information

NPI Number	:	1215061031
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WALMART INC.

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

Provider Business Practice Location Address
First Line	:	3950 W LAKE MEAD BLVD
Second Line	:
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89032-4895
Country	:	US
Telephone Number	:	702-631-6806
Fax Number	:	702-631-7983

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

Provider Enumeration Date	:	03/15/2007
Last Update Date	:	07/08/2025

Similar Medicare Providers

1215261847 — MICHAEL VATHANASAYNEE, O.D. PROFESSIONAL CORPORATION
Practice Location Address:

3950 W LAKE MEAD BLVD
NORTH LAS VEGAS, NV
89032-4895

Practice Phone: 714-926-4384
Practice Fax:

1699375287 — LEAH NEMER PHARM D
Practice Location Address:

3950 W LAKE MEAD BLVD
NORTH LAS VEGAS, NV
89032-4895

Practice Phone: 702-631-6806
Practice Fax: 702-631-7965

1982208583 — DR. JESSICA HUEY PHARMD
Practice Location Address:

3950 W LAKE MEAD BLVD
NORTH LAS VEGAS, NV
89032-4895

Practice Phone: 702-631-6806
Practice Fax: 702-631-7965

1902699499 — NICOLE CLARK LDO
Practice Location Address:

3950 W LAKE MEAD BLVD
NORTH LAS VEGAS, NV
89032-4895

Practice Phone: 702-631-8472
Practice Fax: 702-631-9417

1083810212 — MICHAEL VATHANASAYNEE O.D.
Practice Location Address:

3950 W LAKE MEAD BLVD
N LAS VEGAS, NV
89032-4895

Practice Phone: 702-737-2020
Practice Fax:

1659467009 — PAUL I LEW DDS INC
Practice Location Address:

6314 NORTH RUCKER ROAD , SUITE B
INDIANAPOLIS, IN
46220-4895

Practice Phone: 317-253-8004
Practice Fax: 317-253-3861

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.