Walmart Inc.

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

PHY39340 Issued in CA

Legal business name

WALMART INC.

Practice address

900 Pleasant Grove Blvd
Roseville, CA 95678-6197

Phone

(916) 786-6603

Fax

(916) 786-8177

NPI assigned

Jul 16, 2006

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) 277-6348

Specialties & licenses 3

Addresses

Other identifiers 2

Other names 1

• WALMART PHARMACY 10-1988 Doing business as

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in CA2 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. Dba Wal-Mart

  • Eyewear Supplier
  • Paso Robles, CA
  • NPI 1295822161
  NPD tax ID
• Wal-Mart Stores, Inc Dba Wal-Mart

  • Eyewear Supplier
  • Richmond, CA
  • NPI 1326179748
  NPD tax ID
• Wal-Mart Stores, Inc.

  • Eyewear Supplier
  • Bakersfield, CA
  • NPI 1326137282
  NPD tax ID
• Walmart Inc.

  • Community/Retail Pharmacy
  • Sacramento, CA
  • NPI 1275926446
  NPD tax ID
• Walmart Inc.

  • Community/Retail Pharmacy
  • Camarillo, CA
  • NPI 1275966798
  NPD tax ID
• Walmart Inc.

  • Community/Retail Pharmacy
  • Downey, CA
  • NPI 1275992463
  NPD tax ID
• Walmart Inc.

  • Pharmacy
  • Eastvale, CA
  • NPI 1285590323
  NPD tax ID
• Walmart Inc.

  • Community/Retail Pharmacy
  • Indio, CA
  • NPI 1295265072
  NPD tax ID
• Walmart Inc.

  • Community/Retail Pharmacy
  • Poway, CA
  • NPI 1295752541
  NPD tax ID
• Walmart Inc.

  • Community/Retail Pharmacy
  • Temecula, CA
  • NPI 1295753069
  NPD tax ID
• Walmart Inc.

  • Community/Retail Pharmacy
  • Merced, CA
  • NPI 1306863634
  NPD tax ID
• Walmart Inc.

  • Community/Retail Pharmacy
  • Calexico, CA
  • NPI 1306863725
  NPD tax ID

Locations

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

{
    "created_epoch": "1153008000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1749168000000",
    "number": "1306863626",
    "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": "900 PLEASANT GROVE BLVD",
            "city": "ROSEVILLE",
            "state": "CA",
            "postal_code": "956786197",
            "telephone_number": "916-786-6603",
            "fax_number": "916-786-8177"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WALMART INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-16",
        "last_updated": "2025-06-06",
        "certification_date": "2025-06-06",
        "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": "CA",
            "license": "PHY39340",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2066985",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "463PHA393400",
            "state": "CA"
        }
    ],
    "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 10-1988",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Vanessa Jane Walker, DO
• Craig J. Wall, DO
• Ann Wallace, RD, CDCES
• James Doran Wallace, P.A.,D.C
• Walls Phlebotomy
• Walmart Inc.
• Walmart Stores, Inc.
• Walmart, Inc.
• Jeanine Lynn Walter Misirli, M.D.
• Andrew J. Walter, MD

• Community/Retail Pharmacy in Roseville, CA
• Providers in Roseville, CA by specialty
• Community/Retail Pharmacy in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 6, 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.