Active NPI
Walmart Inc.
- Community/Retail Pharmacy
- Nampa, ID
National Provider Identifier
1013335454
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Community/Retail Pharmacy
- License
- 35993RP
- Legal business name
- WALMART INC.
- Practice address
- 175 N Middleton Rd
Nampa, ID 83651-7538 - Phone
- (208) 546-3396
- Fax
- (208) 546-3338
- NPI assigned
- Apr 2, 2014
- Last updated
- Jun 5, 2025
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Kimberly Canonic
- Title
- Senior Director, Enrollment
- Phone
- (480) 277-6348
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Durable Medical Equipment & Medical Supplies | 332B00000X | NU | ||
| Community/Retail Pharmacy | 3336C0003X | 35993RP | ID | Primary |
Addresses
Primary practice location
175 N Middleton Rd
Nampa, ID 83651-7538
Mailing address
702 SW 8TH St
Bentonville, AR 72716-0445
Phone (479) 204-8550
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 2145078 | Other | PK |
Electronic endpoints 1
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| CONNECT URL | https://esmd.abilitynetwork.com:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRRequest_Service | Other | Ability Network |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in ID
Enrollment records 3
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20130930000003 | ID | Part B Supplier - Mass Immunization (Roster Biller Only) | 4385556745 |
25 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Rexburg, ID; Meridian, ID; Moscow, ID; Mountain Home, ID; Nampa, ID; Ponderay, ID; Post Falls, ID; Smelterville, ID… |
| O20140924000662 | ID | DME Supplier - Pharmacy | 4385556745 | Practice locations: Nampa, ID |
| O20221209001769 | ID | Part B Supplier - Independent Clinical Laboratory | 4385556745 |
25 other NPIs on this enrollment Practice locations: Moscow, ID; Mountain Home, ID; Meridian, ID; Nampa, ID; Ponderay, ID; Post Falls, ID; Rexburg, ID; Smelterville, ID… |
Other NPIs on the same Medicare enrollment 25
NPIs listed together on one Medicare enrollment, typically parts of the same organization.
-
dba WalMart Pharmacy 10-3094
- Community/Retail Pharmacy
- Boise, ID
- NPI 1073945887
O20130930000003, O20221209001769
-
dba Walmart Pharmacy 10-2781
- Community/Retail Pharmacy
- Nampa, ID
- NPI 1083631337
O20130930000003, O20221209001769
-
dba WalMart Pharmacy 10-4395
- Community/Retail Pharmacy
- Post Falls, ID
- NPI 1134430713
O20130930000003, O20221209001769
-
dba Walmart Pharmacy 10-2780
- Community/Retail Pharmacy
- Caldwell, ID
- NPI 1174540421
O20130930000003, O20221209001769
-
dba Walmart Pharmacy 10-1900
- Community/Retail Pharmacy
- Burley, ID
- NPI 1184641433
O20130930000003, O20221209001769
-
dba Walmart Pharmacy 10-5494
- Community/Retail Pharmacy
- Idaho Falls, ID
- NPI 1255358503
O20130930000003, O20221209001769
-
dba Walmart Pharmacy 10-2508
- Community/Retail Pharmacy
- Boise, ID
- NPI 1265459515
O20130930000003, O20221209001769
-
dba Walmart Pharmacy 10-2861
- Community/Retail Pharmacy
- Boise, ID
- NPI 1346267697
O20130930000003, O20221209001769
-
dba Walmart Pharmacy 10-2485
- Community/Retail Pharmacy
- Ponderay, ID
- NPI 1356368609
O20130930000003, O20221209001769
-
dba WalMart Pharmacy 10-3897
- Community/Retail Pharmacy
- Twin Falls, ID
- NPI 1417190315
O20130930000003, O20221209001769
-
dba Walmart Pharmacy 10-3472
- Community/Retail Pharmacy
- Post Falls, ID
- NPI 1437176781
O20130930000003, O20221209001769
National Provider Directory
National Provider Directory- Tax ID family
- Ability Network
Organizations with this tax ID in the same state 12
This tax ID family is large, so up to 24 of its organizations in the same state are linked here.
-
dba Walmart Vision Center 30-4395
- Eyewear Supplier
- Post Falls, ID
- NPI 1194194605
-
- Community/Retail Pharmacy
- Caldwell, ID
- NPI 1093163990
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1396396800000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1749081600000",
"number": "1013335454",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "702 SW 8TH ST",
"city": "BENTONVILLE",
"state": "AR",
"postal_code": "727160445",
"telephone_number": "479-204-8550",
"fax_number": "479-277-4331"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "175 N MIDDLETON RD",
"city": "NAMPA",
"state": "ID",
"postal_code": "836517538",
"telephone_number": "208-546-3396",
"fax_number": "208-546-3338"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "WALMART INC.",
"organizational_subpart": "NO",
"enumeration_date": "2014-04-02",
"last_updated": "2025-06-05",
"certification_date": "2025-06-05",
"status": "A",
"authorized_official_last_name": "CANONIC",
"authorized_official_first_name": "KIMBERLY",
"authorized_official_title_or_position": "SENIOR DIRECTOR, ENROLLMENT",
"authorized_official_telephone_number": "480-277-6348"
},
"taxonomies": [
{
"code": "332B00000X",
"taxonomy_group": "",
"desc": "Durable Medical Equipment & Medical Supplies",
"state": "NU",
"license": null,
"primary": false
},
{
"code": "3336C0003X",
"taxonomy_group": "",
"desc": "Pharmacy, Community/Retail Pharmacy",
"state": "ID",
"license": "35993RP",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PK",
"identifier": "2145078",
"state": null
}
],
"endpoints": [
{
"endpointType": "CONNECT",
"endpointTypeDescription": "CONNECT URL",
"endpoint": "https://esmd.abilitynetwork.com:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRRequest_Service",
"affiliation": "Y",
"endpointDescription": "2.16.840.1.113883.3.667.22.16.840.1.113883.3.667.2",
"affiliationName": "Ability Network",
"use": "OTHER",
"useDescription": "Other",
"useOtherDescription": "CMS esMD eMDR",
"address_1": "100 N 6th St Ste 900A",
"city": "Minneapolis",
"state": "MN",
"country_code": "US",
"postal_code": "554031516",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": []
}Other providers in Nampa, ID
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 5, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.