Walmart Inc.

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

260863 Issued in MN

Legal business name

WALMART INC.

Practice address

4740 Mall Dr
Hermantown, MN 55811-3939

Phone

(218) 727-4625

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) 853-0515

Specialties & licenses 3

Addresses

Other identifiers 2

Other names 1

• WALMART PHARMACY 10-1757 Doing business as

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in MN2 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.

CLIA laboratory certificates

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
  • Faribault, MN
  • NPI 1649329863
  NPD tax ID
• Wal-Mart Stores Inc

  • Eyewear Supplier
  • Princeton, MN
  • NPI 1710221023
  NPD tax ID
• Wal-Mart Stores, Inc

  • Optician
  • Willmar, MN
  • NPI 1639350564
  NPD tax ID
• Wal-Mart Stores, Inc

  • Eyewear Supplier
  • Mountain Iron, MN
  • NPI 1770997686
  NPD tax ID
• Wal-Mart Stores, Inc.

  • Eyewear Supplier
  • Blaine, MN
  • NPI 1639502842
  NPD tax ID
• Wal-Mart Stores, Inc.

  • Eyewear Supplier
  • Apple Valley, MN
  • NPI 1649351792
  NPD tax ID
• Wal-Mart Stores, Inc.

  • Eyewear Supplier
  • Baxter, MN
  • NPI 1669485991
  NPD tax ID
• Wal-Mart Stores, Inc.

  • Eyewear Supplier
  • Bemidji, MN
  • NPI 1699856195
  NPD tax ID
• Wal-Mart Stores, Inc.

  • Optician
  • Oak Park Heights, MN
  • NPI 1700919883
  NPD tax ID
• Wal-Mart Stores, Inc.

  • Eyewear Supplier
  • Hastings, MN
  • NPI 1710068523
  NPD tax ID
• Wal-Mart Stores, Inc.

  • Eyewear Supplier
  • Hermantown, MN
  • NPI 1750464988
  NPD tax ID
• Wal-Mart Stores, Inc.

  • Eyewear Supplier
  • Brooklyn Park, MN
  • NPI 1770663049
  NPD tax ID

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1153008000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1750118400000",
    "number": "1700803178",
    "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": "4740 MALL DR",
            "city": "HERMANTOWN",
            "state": "MN",
            "postal_code": "558113939",
            "telephone_number": "218-727-4625"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WALMART INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-16",
        "last_updated": "2025-06-17",
        "certification_date": "2025-06-17",
        "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": 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": "MN",
            "license": "260863",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2046897",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "888360200",
            "state": "MN"
        }
    ],
    "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 10-1757",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Brian Ronald Von Arb, OD
• Breanna Louise Wagner
• Nora Ann Wagner
• Wal-Mart Stores, Inc.
• Jodi L Walker
• Emilyn Jewel Walters
• Amanda Wangsness
• Sarah Ward, M. ED., BCBA
• Hailey Ruth Webber
• Nicole Weber

• Community/Retail Pharmacy in Hermantown, MN
• Providers in Hermantown, MN by specialty
• Community/Retail Pharmacy in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 17, 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.