Walmart Inc.

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

2-09893 Issued in KS

Legal business name

WALMART INC.

Practice address

9000 Metcalf Ave
Overland Park, KS 66212-1457

Phone

(913) 649-4314

Fax

(913) 649-4483

NPI assigned

Jul 19, 2006

Organization subpart

No

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) 853-0515

Specialties & licenses 3

Addresses

Other identifiers 3

Other names 1

• WALMART PHARMACY 10-5207 Doing business as

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in KS2 enrollments

Enrollment records 2

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

CLIA laboratory certificates

Medicare medical equipment & supply locations

Tax ID family

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

Organizations with this tax ID in the same state 20

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
  • Wichita, KS
  • NPI 1003998055
  NPD tax ID
• Wal-Mart Stores, Inc.

  • Eyewear Supplier
  • Liberal, KS
  • NPI 1013098490
  NPD tax ID
• Wal-Mart Stores, Inc.

  • Eyewear Supplier
  • Augusta, KS
  • NPI 1063880375
  NPD tax ID
• Wal-Mart Stores, Inc.

  • Eyewear Supplier
  • Manhattan, KS
  • NPI 1073699062
  NPD tax ID
• Wal-Mart Stores, Inc.

  • Eyewear Supplier
  • Paola, KS
  • NPI 1093805293
  NPD tax ID
• Wal-Mart Stores, Inc.

  • Eyewear Supplier
  • Salina, KS
  • NPI 1104906866
  NPD tax ID
• Wal-Mart Stores, Inc.

  • Eyewear Supplier
  • Hays, KS
  • NPI 1104907179
  NPD tax ID
• Wal-Mart Stores, Inc.

  • Eyewear Supplier
  • Wichita, KS
  • NPI 1104908151
  NPD tax ID
• Wal-Mart Stores, Inc.

  • Eyewear Supplier
  • Gardner, KS
  • NPI 1104926997
  NPD tax ID
• Wal-Mart Stores, Inc.

  • Optician
  • Wichita, KS
  • NPI 1114708385
  NPD tax ID
• Wal-Mart Stores, Inc.

  • Eyewear Supplier
  • Bonner Springs, KS
  • NPI 1144308180
  NPD tax ID
• Walmart Inc.

  • Community/Retail Pharmacy
  • Marysville, KS
  • NPI 1003833401
  NPD tax ID

Locations

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Christy Lynn Distler, PHARM.D.

  • Pharmacist
  • Overland Park, KS
  • NPI 1093144016
  NPD (past)
• Taylor Jo Kufahl, PHARMD

  • Pharmacist
  • Overland Park, KS
  • NPI 1659099232
  NPD (past)
• Adam Meisinger, PHARMD

  • Pharmacist
  • Overland Park, KS
  • NPI 1548493455
  NPD (past)
• Jennifer Ortolani, RPH

  • Pharmacist
  • Overland Park, KS
  • NPI 1003272063
  NPD (past)
• Lisa Michelle Ozburn-Free, PHARMD

  • Pharmacist
  • Overland Park, KS
  • NPI 1619466786
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1153267200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1749772800000",
    "number": "1083633069",
    "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": "9000 METCALF AVE",
            "city": "OVERLAND PARK",
            "state": "KS",
            "postal_code": "662121457",
            "telephone_number": "913-649-4314",
            "fax_number": "913-649-4483"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WALMART INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-19",
        "last_updated": "2025-06-13",
        "certification_date": "2025-06-13",
        "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": "KS",
            "license": "2-09893",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200004060A",
            "state": "KS"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "606193407",
            "state": "KS"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2027260",
            "state": null
        }
    ],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "https://esmd.abilitynetwork.com:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRRequest_Service",
            "affiliation": "Y",
            "endpointDescription": "2.16.840.1.113883.3.667.2",
            "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": [
        {
            "organization_name": "WALMART PHARMACY 10-5207",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Mark Richard Wallace, DC
• Sabrina Lynne Wallace, M.S., CCC-SLP
• Sarah Elizabeth Walldroff, OTR/L
• Kara B Walling
• Walmart Inc.
• Walmart Inc.
• Walmart Inc.
• Walmart Inc.
• Walter Chiropractic & Wellness LLC
• Caitlin Walter, MA, LCPC

• Community/Retail Pharmacy in Overland Park, KS
• Providers in Overland Park, KS by specialty
• Community/Retail Pharmacy in Kansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 13, 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.