NPIMap

Organization Active NPI

Walmart Inc.

  • Community/Retail Pharmacy
  • Kenai, AK
National Provider Identifier
1285965772
Registry record updated Jul 14, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
License
PHAR470 Issued in AK
Legal business name
WALMART INC.
Practice address
10096 Kenai Spur Hwy
Kenai, AK 99611-7807
Phone
(907) 395-0871
Fax
(907) 395-4038
NPI assigned
Jan 22, 2010
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 14, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Kimberly Canonic
Title
CMS Esmd Emdr
Phone
(480) 853-0515

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Retail Pharmacy 3336C0003X PHAR470 AK Primary

Addresses

Primary practice location

10096 Kenai Spur Hwy
Kenai, AK 99611-7807

Mailing address

702 SW 8TH St
Bentonville, AR 72716-6209
Phone (479) 204-8550

Other identifiers 2

IdentifierTypeStateIssuer
PH0021MedicaidAK
2123564OtherPK

Other names 1

  • Walmart Pharmacy 10-4474 Doing business as

Electronic endpoints 1

TypeEndpointUseAffiliation
CONNECT URL https://esmd.abilitynetwork.com:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRRequest_Service Other Ability Network

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AK3 enrollments

Enrollment records 3

Enrollment IDStateProvider typePAC IDDetails
O20100930045932 AK DME Supplier - Pharmacy 4385556745 Practice locations: Kenai, AK
O20130808000548 AK Part B Supplier - Mass Immunization (Roster Biller Only) 4385556745 9 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Kodiak, AK; Wasilla, AK; Ketchikan, AK; Kenai, AK; Fairbanks, AK; Eagle River, AK; Anchorage, AK
O20231212003400 AK Part B Supplier - Independent Clinical Laboratory 4385556745 8 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Anchorage, AK; Eagle River, AK; Fairbanks, AK; Kenai, AK; Ketchikan, AK; Kodiak, AK; Wasilla, AK

Other NPIs on the same Medicare enrollment 9

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
02D2142240Walmart Supercenter Pharmacy 10-447410096 Kenai Spur Hwy, Kenai, AK 99611Certificate of waiverJan 7, 2028

Medicare medical equipment & supply locations

SupplierSuppliesMedicare assignment
Walmart Pharmacy 10-447410096 Kenai Spur Hwy, Kenai, AK 99611-7807(907) 395-0871 Epoetin|Immunosuppressive 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 assignmentParticipating since Jan 1, 2019

National Provider Directory

National Provider Directory
Tax ID family
Ability Network2,173 organizations share this tax ID, including this one

Organizations with this tax ID in the same state 13

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

View all 13

Locations

10096 Kenai Spur Hwy
Kenai, AK 99611
Phone (907) 395-0871

Practitioners & affiliated clinicians

Practitioners 4

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

NPI Registry JSON

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

{
    "created_epoch": "1264118400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1752451200000",
    "number": "1285965772",
    "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": "479-204-8550",
            "fax_number": "479-277-4331"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10096 KENAI SPUR HWY",
            "city": "KENAI",
            "state": "AK",
            "postal_code": "996117807",
            "telephone_number": "907-395-0871",
            "fax_number": "907-395-4038"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WALMART INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-01-22",
        "last_updated": "2025-07-14",
        "certification_date": "2025-07-14",
        "status": "A",
        "authorized_official_last_name": "CANONIC",
        "authorized_official_first_name": "KIMBERLY",
        "authorized_official_title_or_position": "CMS ESMD EMDR",
        "authorized_official_telephone_number": "480-853-0515"
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "AK",
            "license": "PHAR470",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "PH0021",
            "state": "AK"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2123564",
            "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 10-4474",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Kenai, AK

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 14, 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.