Walmart Inc.

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

59451571703 Issued in UT

Legal business name

WALMART INC.

Practice address

5469 S Redwood Rd
Taylorsville, UT 84123-5318

Phone

(801) 264-9797

NPI assigned

Jul 16, 2006

Organization subpart

No

Name

Kimberly Canonic

Title

Senior Director, Enrollment

Phone

(480) 853-0515

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

Medicare medical equipment & supply locations

Medicare fee-for-service enrollment

Enrolled in UT2 enrollments

Enrollment records 2

Tax ID family

Ability Network2,173 organizations share this tax ID, including this one

Organizations with this tax ID in the same state 16

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

• Wal-Mart Stores, Inc

  • Eyewear Supplier
  • Vernal, UT
  • NPI 1043309370
  NPD tax ID
• Wal-Mart Stores, Inc

  • Eyewear Supplier
  • Lindon, UT
  • NPI 1154402915
  NPD tax ID
• Wal-Mart Stores, Inc

  • Eyewear Supplier
  • Price, UT
  • NPI 1154410025
  NPD tax ID
• Walmart Inc.

  • Community/Retail Pharmacy
  • Syracuse, UT
  • NPI 1013072123
  NPD tax ID
• Walmart Inc.

  • Community/Retail Pharmacy
  • Eagle Mountain, UT
  • NPI 1013800952
  NPD tax ID
• Walmart Inc.

  • Community/Retail Pharmacy
  • Salt Lake City, UT
  • NPI 1023035219
  NPD tax ID
• Walmart Inc.

  • Community/Retail Pharmacy
  • Spanish Fork, UT
  • NPI 1023407533
  NPD tax ID
• Walmart Inc.

  • Community/Retail Pharmacy
  • Riverdale, UT
  • NPI 1043238892
  NPD tax ID
• Walmart Inc.

  • Community/Retail Pharmacy
  • Pleasant Grove, UT
  • NPI 1053723841
  NPD tax ID
• Walmart Inc.

  • Community/Retail Pharmacy
  • West Valley City, UT
  • NPI 1063431054
  NPD tax ID
• Walmart Inc.

  • Community/Retail Pharmacy
  • Draper, UT
  • NPI 1073530275
  NPD tax ID
• Walmart Inc.

  • Community/Retail Pharmacy
  • Cedar Hills, UT
  • NPI 1104063635
  NPD tax ID

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Jul 8, 2025.

{
    "created_epoch": "1153008000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1751932800000",
    "number": "1043237233",
    "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"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5469 S REDWOOD RD",
            "city": "TAYLORSVILLE",
            "state": "UT",
            "postal_code": "841235318",
            "telephone_number": "801-264-9797"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WALMART INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-16",
        "last_updated": "2025-07-08",
        "certification_date": "2025-07-08",
        "status": "A",
        "authorized_official_last_name": "CANONIC",
        "authorized_official_first_name": "KIMBERLY",
        "authorized_official_title_or_position": "SENIOR DIRECTOR, ENROLLMENT",
        "authorized_official_telephone_number": "480-853-0515"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "UT",
            "license": "59451571703",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2099819",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1043237233",
            "state": "OR"
        }
    ],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "https://esmd.abilitynetwork.com:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRRequest_Service",
            "affiliation": "Y",
            "endpointDescription": "2.16.840.1.113883.3.667.2",
            "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": []
}

• Kristan Walker
• Wesley Paul Walker, P.T.
• Eliza Mae Walkoviak
• Madeline Wallace
• Madison Waller
• Leela Walser
• Makayla Walsh
• Gabriela Walsman Leiva, M.D.
• Jacob Walster
• Grace Walton

• All providers in Taylorsville, UT
• Community/Retail Pharmacy in Utah

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.