Active NPI
Walmart Inc.
Doing business as Walmart Pharmacy 10-3407
- Community/Retail Pharmacy
- Buckeye, AZ
National Provider Identifier
1407053747
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Community/Retail Pharmacy
- License
- Y004835
- Legal business name
- WALMART INC.
- Doing business as
- Walmart Pharmacy 10-3407
- Practice address
- 1060 S Watson Rd
Buckeye, AZ 85326-3371 - Phone
- (623) 474-6860
- NPI assigned
- Jun 29, 2007
- Last updated
- Jun 19, 2025
- Organization subpart
- No
NPPES NPI Registry
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
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Durable Medical Equipment & Medical Supplies | 332B00000X | NU | ||
| Community/Retail Pharmacy | 3336C0003X | Y004835 | AZ | Primary |
Addresses
Primary practice location
1060 S Watson Rd
Buckeye, AZ 85326-3371
Mailing address
702 SW 8TH St
Bentonville, AR 72716-0445
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 252010 | Medicaid | AZ | |
| 1992576 | Other | PK |
Other names 1
- WALMART PHARMACY 10-3407
Electronic endpoints 1
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| 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 AZ
Enrollment records 2
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20100930022312 | AZ | DME Supplier - Pharmacy | 4385556745 | Practice locations: Buckeye, AZ |
| O20130722000474 | AZ | Part B Supplier - Mass Immunization (Roster Biller Only) | 4385556745 | This NPI is an additional NPI on the enrollment |
Laboratory certificates & supplier records
Derived by NPIMapThese CMS records do not include an NPI. They are shown because their name and street address match this provider’s.
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 03D2133104 | Walmart Pharmacy 10-3407 | Certificate of waiver | Jul 5, 2027 |
Medicare medical equipment & supply locations
| Supplier | Supplies | Medicare assignment |
|---|---|---|
| Walmart Pharmacy 10-3407 | 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|Prosthetic Lenses: Conventional Eyeglasses|Enteral Nutrients|Surgical Dressings | Does not accept assignment |
National Provider Directory
National Provider Directory- Tax ID family
- Ability Network
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.
-
dba Walmart Pharmacy 10-3751
- Community/Retail Pharmacy
- San Tan Valley, AZ
- NPI 1346307600
-
- Community/Retail Pharmacy
- Sahuarita, AZ
- NPI 1407874837
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1183075200000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1750291200000",
"number": "1407053747",
"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": "1060 S WATSON RD",
"city": "BUCKEYE",
"state": "AZ",
"postal_code": "853263371",
"telephone_number": "623-474-6860"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "WALMART INC.",
"organizational_subpart": "NO",
"enumeration_date": "2007-06-29",
"last_updated": "2025-06-19",
"certification_date": "2025-06-19",
"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": "NU",
"license": null,
"primary": false
},
{
"code": "3336C0003X",
"taxonomy_group": "",
"desc": "Pharmacy, Community/Retail Pharmacy",
"state": "AZ",
"license": "Y004835",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "252010",
"state": "AZ"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PK",
"identifier": "1992576",
"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 10-3407",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in Buckeye, AZ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 19, 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.