Walmart Inc.
Organization Active NPI Community/Retail Pharmacy · Tipton, IA
NPI 1669499166 · NPPES record last updated Jun 3, 2025
Key facts
- NPI
- 1669499166
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Community/Retail Pharmacy 3336C0003X
- License
- 476 (IA)
- Legal business name
- WALMART INC.
- Practice address
- 1126 Highway 38
Tipton, IA 52772-9400 - Phone
- (563) 886-2117
- NPI assigned
- Jul 17, 2006
- Organization subpart
- No
Authorized official
- Name
- Kimberly Canonic
- Title
- Senior Director, Enrollment
- Phone
- (480) 277-6348
Corporate family (same tax ID) 24
Practitioners 3
-
Jane Elizabeth Osborn, PHARM D, RPH
-
Angela Kay Hunt Wolf, MS, PHARMD, RPH
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 16D2130648 | Walmart Pharmacy 10-0841 | Certificate of waiver | May 14, 2027 |
Medicare medical equipment & supply locations
| Supplier | Supplies | Medicare assignment |
|---|---|---|
| Walmart Pharmacy 10-0841 |
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|Enteral Nutrients|Surgical Dressings | Does not accept assignment |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in IA
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20100930000593 | IA | DME Supplier - Pharmacy | 4385556745 | Practice locations: Tipton, IA |
| O20131029001699 | IA | Part B Supplier - Mass Immunization (Roster Biller Only) | 4385556745 | This NPI is an additional NPI on the enrollment |
National Provider Directory
- Tax ID family
- Ability Network
Locations
1128 Highway 38
Tipton, IA 52772
Phone (563) 886-2117
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Durable Medical Equipment & Medical Supplies | 332B00000X | |||
| Pharmacy | 333600000X | |||
| Community/Retail Pharmacy | 3336C0003X | 476 | IA | Yes |
Addresses
Primary practice location
1126 Highway 38
Tipton, IA 52772-9400
Mailing address
702 SW 8TH St
Bentonville, AR 72716-0445
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 2028006 | Other | PK | |
| 0232165 | Medicaid | IA | |
| 232165 | Medicaid | IA |
Other names
- WALMART PHARMACY 10-0841
Electronic endpoints
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| CONNECT URL | https://esmd.abilitynetwork.com:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRRequest_Service | Other | Ability Network |
Other providers in Tipton, IA
- Tipton Community School
- Su Hsin Liao Tung
- Van Den Berghe Chiropractic LLC
- Deborah Lorraine Vandergaast
- Ryan Waack
- Cynthia Weber
- Lindsey Anne Willey
- Marlon Emil Williams Sr.
- Angela Kay Hunt Wolf
- Justine Marie Wood
All providers in Tipton, IA · Community/Retail Pharmacy in Iowa
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 3, 2025. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.