Walmart Inc.

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

Y004942 Issued in AZ

Legal business name

WALMART INC.

Practice address

21055 E Rittenhouse Rd
Queen Creek, AZ 85142-4477

Phone

(480) 457-1158

NPI assigned

Dec 31, 2007

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 10-4451 Doing business as

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in AZ2 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
  • Green Valley, AZ
  • NPI 1235227877
  NPD tax ID
• Wal-Mart Stores, Inc.

  • Eyewear Supplier
  • Phoenix, AZ
  • NPI 1275696361
  NPD tax ID
• Wal-Mart Stores, Inc.

  • Eyewear Supplier
  • Gilbert, AZ
  • NPI 1295931137
  NPD tax ID
• Walmart Inc.

  • Community/Retail Pharmacy
  • Phoenix, AZ
  • NPI 1245257450
  NPD tax ID
• Walmart Inc.

  • Community/Retail Pharmacy
  • Phoenix, AZ
  • NPI 1245411818
  NPD tax ID
• Walmart Inc.

  • Community/Retail Pharmacy
  • Payson, AZ
  • NPI 1255358461
  NPD tax ID
• Walmart Inc.

  • Community/Retail Pharmacy
  • Bullhead City, AZ
  • NPI 1255358479
  NPD tax ID
• Walmart Inc.

  • Community/Retail Pharmacy
  • Phoenix, AZ
  • NPI 1255358628
  NPD tax ID
• Walmart Inc.

  • Community/Retail Pharmacy
  • Maricopa, AZ
  • NPI 1255573903
  NPD tax ID
• Walmart Inc.

  • Community/Retail Pharmacy
  • Sierra Vista, AZ
  • NPI 1265459473
  NPD tax ID
• Walmart Inc.

  • Community/Retail Pharmacy
  • Phoenix, AZ
  • NPI 1265597215
  NPD tax ID
• Walmart Inc.

  • Community/Retail Pharmacy
  • Parker, AZ
  • NPI 1306070289
  NPD tax ID

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

{
    "created_epoch": "1199059200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1752105600000",
    "number": "1285819938",
    "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": "21055 E RITTENHOUSE RD",
            "city": "QUEEN CREEK",
            "state": "AZ",
            "postal_code": "851424477",
            "telephone_number": "480-457-1158"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WALMART INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-12-31",
        "last_updated": "2025-07-10",
        "certification_date": "2025-07-10",
        "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": "AZ",
            "license": "Y004942",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "1992662",
            "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 10-4451",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Wal-Mart Stores, Inc.
• Wal-Mart Stores, Inc.
• Walgreen Co
• Walgreen Co
• Scott Dee Wallin, D.D.S.
• Walter M Dise
• Brandon Wan, DO
• Tiffany Wangard, LACTATION CONSULTANT
• James Burt Ward, D.C.
• Terry Watson, AGACNP-BC

• Community/Retail Pharmacy in Queen Creek, AZ
• Providers in Queen Creek, AZ by specialty
• Community/Retail Pharmacy in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 10, 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.