Walmart Inc.

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

054008959 Issued in IL

Legal business name

WALMART INC.

Practice address

125 E Bestor Dr
Geneseo, IL 61254-1972

Phone

(309) 944-5675

NPI assigned

Jul 16, 2006

Organization subpart

No

Name

Kimberly Canonic

Title

Senior Director, Enrollment

Phone

(480) 277-6348

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

• John David Gustafson, RPH

  • Pharmacist
  • Geneseo, IL
  • NPI 1780225789
  NPD (past)
• Beth Ann Jacobs

  • Pharmacist
  • Geneseo, IL
  • NPI 1841821097
  NPD (past)
• Thuy Tien H Nguyen

  • Pharmacist
  • Geneseo, IL
  • NPI 1952285801
  NPD (past)

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 IL2 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 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
  • Highland, IL
  • NPI 1124109962
  NPD tax ID
• Wal-Mart Stores, Inc

  • Optician
  • Crestwood, IL
  • NPI 1144303702
  NPD tax ID
• Wal-Mart Stores, Inc

  • Eyewear Supplier
  • Morris, IL
  • NPI 1144308446
  NPD tax ID
• Wal-Mart Stores, Inc

  • Eyewear Supplier
  • Du Quoin, IL
  • NPI 1164503272
  NPD tax ID
• Wal-Mart Stores, Inc

  • Eyewear Supplier
  • Niles, IL
  • NPI 1174604185
  NPD tax ID
• Wal-Mart Stores, Inc

  • Eyewear Supplier
  • Belvidere, IL
  • NPI 1174608475
  NPD tax ID
• Wal-Mart Stores, Inc

  • Eyewear Supplier
  • Addison, IL
  • NPI 1225111800
  NPD tax ID
• Wal-Mart Stores, Inc. Dba Wal-Mart

  • Eyewear Supplier
  • Pontiac, IL
  • NPI 1225168750
  NPD tax ID
• Walmart Inc.

  • Community/Retail Pharmacy
  • Mattoon, IL
  • NPI 1124045406
  NPD tax ID
• Walmart Inc.

  • Community/Retail Pharmacy
  • Algonquin, IL
  • NPI 1124045422
  NPD tax ID
• Walmart Inc.

  • Community/Retail Pharmacy
  • Robinson, IL
  • NPI 1124045497
  NPD tax ID
• Walmart Inc.

  • Community/Retail Pharmacy
  • New Lenox, IL
  • NPI 1124335187
  NPD tax ID

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Jun 4, 2025.

{
    "created_epoch": "1153008000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1748995200000",
    "number": "1174540439",
    "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": "125 E BESTOR DR",
            "city": "GENESEO",
            "state": "IL",
            "postal_code": "612541972",
            "telephone_number": "309-944-5675"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WALMART INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-16",
        "last_updated": "2025-06-04",
        "certification_date": "2025-06-04",
        "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": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "IL",
            "license": "054008959",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2018980",
            "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": []
}

• Aaron Thomas Wachtel, D.D.S.
• Pamela Wachtel, PH.D
• Thomas Joseph Wachtel, D.D.S.
• Walgreen Co
• Walgreen Co.
• Kara Wiedenhoeft
• Ryan J Wilson, O.D.
• Becky Ann Wipfler
• Marcia Ann Wirth, DIETICIAN
• Hailey M Wise, M.S, CF-SLP

• All providers in Geneseo, IL
• Community/Retail Pharmacy in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 4, 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.