Walmart Inc.

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

054011424 Issued in IL

Legal business name

WALMART INC.

Practice address

6495 Country Club Rd
Murphysboro, IL 62966-5202

Phone

(618) 684-4419

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 1

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in IL2 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.

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
  • Princeton, IL
  • NPI 1295816189
  NPD tax ID
• Wal-Mart Stores, Inc

  • Eyewear Supplier
  • Glen Ellyn, IL
  • NPI 1295816296
  NPD tax ID
• Wal-Mart Stores, Inc

  • Eyewear Supplier
  • Decatur, IL
  • NPI 1306929955
  NPD tax ID
• Wal-Mart Stores, Inc

  • Eyewear Supplier
  • Mattoon, IL
  • NPI 1326121559
  NPD tax ID
• Wal-Mart Stores, Inc

  • Eyewear Supplier
  • East Peoria, IL
  • NPI 1326122409
  NPD tax ID
• Wal-Mart Stores, Inc

  • Eyewear Supplier
  • Springfield, IL
  • NPI 1326129347
  NPD tax ID
• Wal-Mart Stores, Inc

  • Optician
  • Crystal Lake, IL
  • NPI 1326229253
  NPD tax ID
• Wal-Mart Stores, Inc

  • Eyewear Supplier
  • Decatur, IL
  • NPI 1336223973
  NPD tax ID
• Wal-Mart Stores, Inc.

  • Optician
  • Bradley, IL
  • NPI 1316116015
  NPD tax ID
• Walmart Inc

  • Pharmacy
  • Collinsville, IL
  • NPI 1255865853
  NPD tax ID
• Walmart Inc.

  • Community/Retail Pharmacy
  • Lockport, IL
  • NPI 1255530739
  NPD tax ID
• Walmart Inc.

  • Community/Retail Pharmacy
  • Rock Falls, IL
  • NPI 1265459523
  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": "1748476800000",
    "number": "1306863683",
    "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": "6495 COUNTRY CLUB RD",
            "city": "MURPHYSBORO",
            "state": "IL",
            "postal_code": "629665202",
            "telephone_number": "618-684-4419"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WALMART INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-16",
        "last_updated": "2025-05-29",
        "certification_date": "2025-05-29",
        "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": "IL",
            "license": "054011424",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2022138",
            "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": []
}

• Frederick Christiaan Venter, MD
• Vna Homecare, Inc.
• Vna Homecare, Inc.
• Walgreen Co
• Walgreen Co.
• Brandy Warner, CCC-SLP
• Gina Derosa Warren, M.S., BCBA
• Christine Annette Watt, OTR/L
• Andrea Maren Whipple, LCPC
• Bobbie Lynn Whitacre, D.C.

• Community/Retail Pharmacy in Murphysboro, IL
• Providers in Murphysboro, IL by specialty
• Community/Retail Pharmacy in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 29, 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.