Active NPI
Walmart Inc.
Doing business as Walmart Pharmacy 10-2862
- Community/Retail Pharmacy
- Meridian, ID
National Provider Identifier
1619994969
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Community/Retail Pharmacy
- License
- 1575RP
- Legal business name
- WALMART INC.
- Doing business as
- Walmart Pharmacy 10-2862
- Practice address
- 4051 E Fairview Ave
Meridian, ID 83642-5801 - Phone
- (208) 373-0024
- NPI assigned
- Jul 16, 2006
- Last updated
- Sep 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
- Sarah Little
- Title
- Director of Healthcare Contracting
- Phone
- (479) 277-2500
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Durable Medical Equipment & Medical Supplies | 332B00000X | NU | ||
| Pharmacy | 333600000X | NU | ||
| Community/Retail Pharmacy | 3336C0003X | 1575RP | ID | Primary |
Addresses
Primary practice location
4051 E Fairview Ave
Meridian, ID 83642-5801
Mailing address
702 SW 8TH St
Bentonville, AR 72716-0445
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 2021751 | Other | PK | |
| 806001500 | Medicaid | ID |
Other names 1
- WALMART PHARMACY 10-2862
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 ID
Enrollment records 3
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20100930037919 | ID | DME Supplier - Pharmacy | 4385556745 | Practice locations: Meridian, ID |
| O20130930000003 | ID | Part B Supplier - Mass Immunization (Roster Biller Only) | 4385556745 |
25 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Rexburg, ID; Meridian, ID; Moscow, ID; Mountain Home, ID; Nampa, ID; Ponderay, ID; Post Falls, ID; Smelterville, ID… |
| O20221209001769 | ID | Part B Supplier - Independent Clinical Laboratory | 4385556745 |
25 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Moscow, ID; Mountain Home, ID; Meridian, ID; Nampa, ID; Ponderay, ID; Post Falls, ID; Rexburg, ID; Smelterville, ID… |
Other NPIs on the same Medicare enrollment 25
NPIs listed together on one Medicare enrollment, typically parts of the same organization.
-
dba WalMart Pharmacy 10-3094
- Community/Retail Pharmacy
- Boise, ID
- NPI 1073945887
O20130930000003, O20221209001769
-
dba Walmart Pharmacy 10-2781
- Community/Retail Pharmacy
- Nampa, ID
- NPI 1083631337
O20130930000003, O20221209001769
-
dba WalMart Pharmacy 10-4395
- Community/Retail Pharmacy
- Post Falls, ID
- NPI 1134430713
O20130930000003, O20221209001769
-
dba Walmart Pharmacy 10-2780
- Community/Retail Pharmacy
- Caldwell, ID
- NPI 1174540421
O20130930000003, O20221209001769
-
dba Walmart Pharmacy 10-1900
- Community/Retail Pharmacy
- Burley, ID
- NPI 1184641433
O20130930000003, O20221209001769
-
dba Walmart Pharmacy 10-5494
- Community/Retail Pharmacy
- Idaho Falls, ID
- NPI 1255358503
O20130930000003, O20221209001769
-
dba Walmart Pharmacy 10-2508
- Community/Retail Pharmacy
- Boise, ID
- NPI 1265459515
O20130930000003, O20221209001769
-
dba Walmart Pharmacy 10-2861
- Community/Retail Pharmacy
- Boise, ID
- NPI 1346267697
O20130930000003, O20221209001769
-
dba Walmart Pharmacy 10-2485
- Community/Retail Pharmacy
- Ponderay, ID
- NPI 1356368609
O20130930000003, O20221209001769
-
dba WalMart Pharmacy 10-3897
- Community/Retail Pharmacy
- Twin Falls, ID
- NPI 1417190315
O20130930000003, O20221209001769
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 |
|---|---|---|---|
| 13D2136815 | Walmart Pharmacy 10-2862 | Certificate of waiver | Sep 14, 2027 |
Medicare medical equipment & supply locations
| Supplier | Supplies | Medicare assignment |
|---|---|---|
| Walmart Pharmacy 10-2862 | 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 Vision Center 30-5841
- Eyewear Supplier
- Meridian, ID
- NPI 1831567353
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1153008000000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1758240000000",
"number": "1619994969",
"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": "4051 E FAIRVIEW AVE",
"city": "MERIDIAN",
"state": "ID",
"postal_code": "836425801",
"telephone_number": "208-373-0024"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "WALMART INC.",
"organizational_subpart": "NO",
"enumeration_date": "2006-07-16",
"last_updated": "2025-09-19",
"certification_date": "2023-08-29",
"status": "A",
"authorized_official_last_name": "LITTLE",
"authorized_official_first_name": "SARAH",
"authorized_official_title_or_position": "DIRECTOR OF HEALTHCARE CONTRACTING",
"authorized_official_telephone_number": "479-277-2500"
},
"taxonomies": [
{
"code": "332B00000X",
"taxonomy_group": "",
"desc": "Durable Medical Equipment & Medical Supplies",
"state": "NU",
"license": null,
"primary": false
},
{
"code": "333600000X",
"taxonomy_group": "",
"desc": "Pharmacy",
"state": "NU",
"license": null,
"primary": false
},
{
"code": "3336C0003X",
"taxonomy_group": "",
"desc": "Pharmacy, Community/Retail Pharmacy",
"state": "ID",
"license": "1575RP",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PK",
"identifier": "2021751",
"state": null
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "806001500",
"state": "ID"
}
],
"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 10-2862",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in Meridian, ID
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 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.