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NPI Code Detail

MEDICARE: WALMART INC.

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
1332B00000XDurable Medical Equipment & Medical Supplies
23336C0003XCommunity/Retail PharmacyPHY51057CA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
12136606OTHERPK

General Provider Information

NPI Number : 1982952941
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 : 72716-6209
Country : US
Telephone Number : 479-277-1238
Fax Number : 479-277-4331
Provider Business Practice Location Address
First Line : 2240 S BRADLEY RD
Second Line :
City : SANTA MARIA
State : CA
Zip : 93455-1348
Country : US
Telephone Number : 805-348-4956
Fax Number : 805-348-4952
Authorized Official
Title or Position : SENIOR DIRECTOR, ENROLLMENT
Name : KIMBERLY CANONIC
Credential :
Telephone Number : 480-277-6348
Provider Enumeration Date : 08/23/2012
Last Update Date : 06/05/2025

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Directions to “WALMART INC. ” Practice Location

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