Walmart Inc.

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

1377 Issued in IA

Legal business name

WALMART INC.

Practice address

2150 E 1St St
Grimes, IA 50111-7606

Phone

(515) 986-3657

NPI assigned

Jun 29, 2010

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 2

Addresses

Other identifiers 1

Other names 1

• Walmart Pharmacy 10-5748 Doing business as

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in IA2 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

  • Optician
  • Ames, IA
  • NPI 1245409200
  NPD tax ID
• Wal-Mart Stores, Inc.

  • Eyewear Supplier
  • Atlantic, IA
  • NPI 1114008919
  NPD tax ID
• Wal-Mart Stores, Inc.

  • Eyewear Supplier
  • Davenport, IA
  • NPI 1134200967
  NPD tax ID
• Wal-Mart Stores, Inc.

  • Eyewear Supplier
  • Cedar Rapids, IA
  • NPI 1154402204
  NPD tax ID
• Wal-Mart Stores, Inc.

  • Eyewear Supplier
  • Muscatine, IA
  • NPI 1154402295
  NPD tax ID
• Wal-Mart Stores, Inc.

  • Eyewear Supplier
  • Keokuk, IA
  • NPI 1154404770
  NPD tax ID
• Wal-Mart Stores, Inc.

  • Eyewear Supplier
  • Iowa City, IA
  • NPI 1174604995
  NPD tax ID
• Wal-Mart Stores, Inc.

  • Eyewear Supplier
  • Cedar Falls, IA
  • NPI 1235210378
  NPD tax ID
• Wal-Mart Stores, Inc.

  • Eyewear Supplier
  • Cedar Rapids, IA
  • NPI 1275614091
  NPD tax ID
• Wal-Mart Stores, Inc.

  • Eyewear Supplier
  • Waverly, IA
  • NPI 1295816452
  NPD tax ID
• Wal-Mart Stores, Inc.

  • Eyewear Supplier
  • Davenport, IA
  • NPI 1306927405
  NPD tax ID
• Wal-Mart Stores, Inc.

  • Optician
  • Carroll, IA
  • NPI 1356510317
  NPD tax ID

Locations

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

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

{
    "created_epoch": "1277769600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1751932800000",
    "number": "1275844854",
    "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": "727166209",
            "telephone_number": "479-277-1238",
            "fax_number": "479-277-4331"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2150 E 1ST ST",
            "city": "GRIMES",
            "state": "IA",
            "postal_code": "501117606",
            "telephone_number": "515-986-3657"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WALMART INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-06-29",
        "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": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "IA",
            "license": "1377",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2125811",
            "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 10-5748",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• All providers in Grimes, IA
• Community/Retail Pharmacy in Iowa

• 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.