Active NPI
Walmart Inc.
Doing business as Walmart Pharmacy 10-5269
- Community/Retail Pharmacy
- Las Vegas, NV
National Provider Identifier
1679592687
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Community/Retail Pharmacy
- License
- PH01985
- Legal business name
- WALMART INC.
- Doing business as
- Walmart Pharmacy 10-5269
- Practice address
- 490 E Silverado Ranch Blvd
Las Vegas, NV 89183-6290 - Phone
- (702) 263-4270
- NPI assigned
- Jul 19, 2006
- Last updated
- Jun 13, 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 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Durable Medical Equipment & Medical Supplies | 332B00000X | NU | ||
| Pharmacy | 333600000X | NU | ||
| Community/Retail Pharmacy | 3336C0003X | PH01985 | NV | Primary |
Addresses
Primary practice location
490 E Silverado Ranch Blvd
Las Vegas, NV 89183-6290
Mailing address
702 SW 8TH Street
Bentonville, AR 72716-0445
Phone (479) 277-1242
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 2051671 | Other | PK | |
| 100505343 | Medicaid | NV |
Other names 1
- WALMART PHARMACY 10-5269
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 NV
Enrollment records 3
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20100930028815 | NV | DME Supplier - Pharmacy | 4385556745 | Practice locations: Las Vegas, NV |
| O20151005001178 | NV | Part B Supplier - Mass Immunization (Roster Biller Only) | 4385556745 |
43 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: N Las Vegas, NV; Las Vegas, NV; Mesquite, NV; North Las Vegas, NV; Pahrump, NV; Reno, NV; Sparks, NV; Winnemucca, NV… |
| O20231019000642 | NV | Part B Supplier - Independent Clinical Laboratory | 4385556745 |
42 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Las Vegas, NV; Mesquite, NV; N Las Vegas, NV; North Las Vegas, NV; Pahrump, NV; Reno, NV; Sparks, NV; Winnemucca, NV… |
Other NPIs on the same Medicare enrollment 43
NPIs listed together on one Medicare enrollment, typically parts of the same organization.
-
dba Wal-Mart Pharmacy 10-2837
- Community/Retail Pharmacy
- Las Vegas, NV
- NPI 1982621090
O20151005001178
-
dba Walmart Pharmacy 10-2189
- Community/Retail Pharmacy
- Reno, NV
- NPI 1023036787
O20151005001178, O20231019000642
-
dba Walmart Pharmacy 10-2050
- Community/Retail Pharmacy
- Henderson, NV
- NPI 1043237142
O20151005001178, O20231019000642
-
dba Walmart Pharmacy 10-3355
- Community/Retail Pharmacy
- Las Vegas, NV
- NPI 1053338160
O20151005001178, O20231019000642
-
dba Wal-Mart Pharmacy 10-2402
- Community/Retail Pharmacy
- Elko, NV
- NPI 1083631196
O20151005001178, O20231019000642
-
dba Walmart Pharmacy 10-1838
- Community/Retail Pharmacy
- Las Vegas, NV
- NPI 1134146236
O20151005001178, O20231019000642
-
dba Walmart Pharmacy 10-3847
- Community/Retail Pharmacy
- Mesquite, NV
- NPI 1144247255
O20151005001178, O20231019000642
-
dba Walmart Pharmacy 10-3473
- Community/Retail Pharmacy
- Las Vegas, NV
- NPI 1154348266
O20151005001178, O20231019000642
-
dba Walmart Pharmacy 10-3254
- Community/Retail Pharmacy
- Reno, NV
- NPI 1164449278
O20151005001178, O20231019000642
-
dba Walmart Pharmacy 10-3728
- Community/Retail Pharmacy
- North Las Vegas, NV
- NPI 1215061031
O20151005001178, O20231019000642
-
dba Walmart Pharmacy 10-1560
- Community/Retail Pharmacy
- Las Vegas, NV
- NPI 1225055320
O20151005001178, O20231019000642
-
dba Walmart Pharmacy 10-3729
- Community/Retail Pharmacy
- Sparks, NV
- NPI 1235156340
O20151005001178, O20231019000642
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 Wal-Mart Vision Center 30-3350
- Eyewear Supplier
- Las Vegas, NV
- NPI 1790840692
Practitioners & affiliated clinicians
Practitioners 3
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.
-
- Pharmacist
- Las Vegas, NV
- NPI 1356941587
-
- Pharmacist
- Las Vegas, NV
- NPI 1538198528
-
- Pharmacist
- Las Vegas, NV
- NPI 1932576840
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1153267200000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1749772800000",
"number": "1679592687",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "702 SW 8TH STREET",
"city": "BENTONVILLE",
"state": "AR",
"postal_code": "727160445",
"telephone_number": "479-277-1242"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "490 E SILVERADO RANCH BLVD",
"city": "LAS VEGAS",
"state": "NV",
"postal_code": "891836290",
"telephone_number": "702-263-4270"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "WALMART INC.",
"organizational_subpart": "NO",
"enumeration_date": "2006-07-19",
"last_updated": "2025-06-13",
"certification_date": "2025-06-13",
"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": "333600000X",
"taxonomy_group": "",
"desc": "Pharmacy",
"state": "NU",
"license": null,
"primary": false
},
{
"code": "3336C0003X",
"taxonomy_group": "",
"desc": "Pharmacy, Community/Retail Pharmacy",
"state": "NV",
"license": "PH01985",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PK",
"identifier": "2051671",
"state": null
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "100505343",
"state": "NV"
}
],
"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 10-5269",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in Las Vegas, NV
- Walmart Inc. (Walmart Pharmacy 10-1559)
- Walmart Inc. (Walmart Pharmacy 10-3350)
- Walmart Inc. (Walmart Pharmacy 10-2593)
- Walmart Inc. (WalMart Pharmacy 10-4557)
- Walmart Inc. (Walmart Pharmacy 10-2884)
- Walmart Inc.
- Walmart Inc. (Walmart Pharmacy 10-5423)
- Walmart Inc. (Walmart Pharmacy 10-5259)
- Walmart Inc. (Walmart Pharmacy 10-3788)
- Walmart Inc. (Walmart Pharmacy 10-5258)
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 13, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.