Walmart Inc.
Organization Active NPI Community/Retail Pharmacy · Pittsburg, KS
NPI 1275907784 · NPPES record last updated Jun 10, 2025
Key facts
- NPI
- 1275907784
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Community/Retail Pharmacy 3336C0003X
- License
- 2-13209 (KS)
- Legal business name
- WALMART INC.
- Practice address
- 1011 E Centennial Dr
Pittsburg, KS 66762-6603 - Phone
- (620) 308-7110
- Fax
- (620) 308-7109
- NPI assigned
- Nov 20, 2015
- Organization subpart
- No
Authorized official
- Name
- Kimberly Canonic
- Title
- Senior Director, Enrollment
- Phone
- (480) 277-6348
Corporate family (same tax ID) 24
Practitioners 2
-
Kelsey Suzanne Burford, PHARMD
Laboratory certificates & supplier records
Medicare medical equipment & supply locations
| Supplier | Supplies | Medicare assignment |
|---|---|---|
| Walmart Pharmacy 10-5791 |
Epoetin|Immunosuppressive Drugs|Infusion 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 KS
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20131011000473 | KS | Part B Supplier - Mass Immunization (Roster Biller Only) | 4385556745 | This NPI is an additional NPI on the enrollment |
| O20160526002547 | KS | DME Supplier - Pharmacy | 4385556745 | Practice locations: Pittsburg, KS |
National Provider Directory
- Tax ID family
- Ability Network
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Durable Medical Equipment & Medical Supplies | 332B00000X | |||
| Pharmacy | 333600000X | |||
| Community/Retail Pharmacy | 3336C0003X | 2-13209 | KS | Yes |
Addresses
Primary practice location
1011 E Centennial Dr
Pittsburg, KS 66762-6603
Mailing address
702 SW 8TH St
Bentonville, AR 72716-0445
Phone (479) 204-8550
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 2155636 | Other | PK | |
| 100432830U | Medicaid | KS | |
| 100432830V | Medicaid | KS |
Other names
- Walmart Pharmacy 10-5791
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 Pittsburg, KS
- Terry Ray Waggoner II
- Stephanie Michelle Wagner
- Wal-Mart Stores, Inc.
- Walgreen Co
- Walmart Inc.
- Breanna M Ward
- Hailey Ward
- Mayra Lizbeth Watson
- Jodi Weber
- Josie I Welch
All providers in Pittsburg, KS · Community/Retail Pharmacy in Kansas
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 10, 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.