Walmart Inc.
Organization Active NPI Community/Retail Pharmacy · Cedar Hills, UT
NPI 1104063635 · NPPES record last updated Sep 19, 2025
Key facts
- NPI
- 1104063635
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Community/Retail Pharmacy 3336C0003X
- License
- 7218631-1703 (UT)
- Legal business name
- WALMART INC.
- Practice address
- 4689 W Cedar Hills Dr
Cedar Hills, UT 84062-8093 - Phone
- (801) 756-5067
- NPI assigned
- Jan 21, 2009
- Organization subpart
- No
Authorized official
- Name
- Sarah Little
- Title
- Director of Healthcare Contracting
- Phone
- (479) 277-2500
Corporate family (same tax ID) 22
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 46D2120653 | Walmart Pharmacy 10-4689 | Certificate of waiver | Oct 19, 2026 |
Medicare medical equipment & supply locations
| Supplier | Supplies | Medicare assignment |
|---|---|---|
| Wal-Mart Pharmacy 10-4689 |
Epoetin|Immunosuppressive Drugs|Nebulizer Drugs|Oral Anticancer Drugs|Oral Antiemetic Drugs|Blood Glucose Monitors/Supplies (Non-Mail Order)|Blood Glucose Monitors/Supplies (Mail Order)|Ostomy Supplies|Enteral Nutrients|Surgical Dressings | Does not accept assignment |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in UT
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20100930073561 | UT | DME Supplier - Pharmacy | 4385556745 | Practice locations: Cedar Hills, UT |
| O20131009000800 | UT | Part B Supplier - Mass Immunization (Roster Biller Only) | 4385556745 | This NPI is an additional NPI on the enrollment |
National Provider Directory
- Tax ID family
- Ability Network
Locations
4689 W Cedar Hills Dr
Cedar Hills, UT 84062
Phone (801) 756-5067
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Community/Retail Pharmacy | 3336C0003X | 7218631-1703 | UT | Yes |
Addresses
Primary practice location
4689 W Cedar Hills Dr
Cedar Hills, UT 84062-8093
Mailing address
702 SW 8TH St
Bentonville, AR 72716
Phone (479) 277-1238
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1104063635 | Medicaid | UT | |
| 2118803 | Other | PK |
Other names
- WalMart Pharmacy 10-4689
Electronic endpoints
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| CONNECT URL | https://esmd.abilitynetwork.com:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRRequest_Service | Other | Ability Network |
Other providers in Cedar Hills, UT
- Rachel Ellen Strebel
- The Charleston at Cedar Hills
- Kara Cattani Thompson
- Dana Tischler
- Ut Specialty Dental Services, PLLC
- Joslyn Dana Wilson
- Kelsie Lenna Wimmer
- Craig Young
All providers in Cedar Hills, UT · Community/Retail Pharmacy in Utah
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 19, 2025. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.