Walmart Inc.

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

2-13054 Issued in KS

Legal business name

WALMART INC.

Practice address

2630 SE California Ave
Topeka, KS 66605-1709

Phone

(785) 379-2344

Fax

(785) 379-2345

NPI assigned

Aug 26, 2014

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) 277-6348

Specialties & licenses 2

Addresses

Other identifiers 2

Other names 1

• Walmart Pharmacy 10-6392 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 24

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
• Wal-Mart Stores, Inc.

  • Eyewear Supplier
  • Parsons, KS
  • NPI 1154402527
  NPD tax ID

Locations

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

{
    "created_epoch": "1409011200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1749081600000",
    "number": "1104226307",
    "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": "2630 SE CALIFORNIA AVE",
            "city": "TOPEKA",
            "state": "KS",
            "postal_code": "666051709",
            "telephone_number": "785-379-2344",
            "fax_number": "785-379-2345"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WALMART INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-08-26",
        "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": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "KS",
            "license": "2-13054",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100432830K",
            "state": "KS"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2147570",
            "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 10-6392",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Tara Wallace
• Melvin Joe Waller, CRNA
• Philliip G Wallsmith, CADC
• Timothy R Walmann, MD
• Walmart Inc.
• Walmart Inc.
• Walmart Inc.
• Walmart Inc.
• Walmart, Inc.
• Janna Marie Walpole, LMSW

• All providers in Topeka, KS
• Community/Retail Pharmacy in Kansas

• 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.
• 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.