Walmart Inc.

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

716 Issued in IA

Legal business name

WALMART INC.

Practice address

5101 SE 14TH St
Des Moines, IA 50320-1609

Phone

(515) 287-7748

NPI assigned

Jul 16, 2006

Organization subpart

No

Name

Kimberly Canonic

Title

Senior Director, Enrollment

Phone

(480) 853-0515

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

Medicare fee-for-service enrollment

Enrolled in IA2 enrollments

Enrollment records 2

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
  • Altoona, IA
  • NPI 1649353285
  NPD tax ID
• Wal-Mart Stores, Inc.

  • Eyewear Supplier
  • Marshalltown, IA
  • NPI 1649353913
  NPD tax ID
• Wal-Mart Stores, Inc.

  • Eyewear Supplier
  • Storm Lake, IA
  • NPI 1659452753
  NPD tax ID
• Wal-Mart Stores, Inc.

  • Eyewear Supplier
  • Fort Dodge, IA
  • NPI 1689755571
  NPD tax ID
• Wal-Mart Stores, Inc.

  • Eyewear Supplier
  • Coralville, IA
  • NPI 1700967536
  NPD tax ID
• Wal-Mart Stores, Inc.

  • Eyewear Supplier
  • Windsor Heights, IA
  • NPI 1730260837
  NPD tax ID
• Wal-Mart Stores, Inc.

  • Eyewear Supplier
  • Spirit Lake, IA
  • NPI 1730262007
  NPD tax ID
• Wal-Mart Stores, Inc.

  • Eyewear Supplier
  • Spencer, IA
  • NPI 1740361740
  NPD tax ID
• Wal-Mart Stores, Inc.

  • Eyewear Supplier
  • Decorah, IA
  • NPI 1750462800
  NPD tax ID
• Wal-Mart Stores, Inc.

  • Eyewear Supplier
  • Waterloo, IA
  • NPI 1801977608
  NPD tax ID
• Walmart Inc.

  • Community/Retail Pharmacy
  • Mt Pleasant, IA
  • NPI 1649297011
  NPD tax ID
• Walmart Inc.

  • Community/Retail Pharmacy
  • Iowa Falls, IA
  • NPI 1649297029
  NPD tax ID

• WALMART PHARMACY 10-1723 Doing business as

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Jun 18, 2025.

{
    "created_epoch": "1153008000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1750204800000",
    "number": "1720005101",
    "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": "5101 SE 14TH ST",
            "city": "DES MOINES",
            "state": "IA",
            "postal_code": "503201609",
            "telephone_number": "515-287-7748"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WALMART INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-16",
        "last_updated": "2025-06-18",
        "certification_date": "2025-06-18",
        "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": "IA",
            "license": "716",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0078725",
            "state": "IA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "78725",
            "state": "IA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2028886",
            "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 10-1723",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Daniel Mark Waller, MD
• Heather Walles
• Amber Audrey Wallingford, LMSW
• Ashley Wallingford
• Rachel M Wallish, PT, DPT
• Dianne Walsh, LISW
• Walter J Riley MD PC
• Mason Christoph Walter, COTA
• Trinity M Walter, PA-C
• Dorothy J Walters, AU.D.

• All providers in Des Moines, IA
• Community/Retail Pharmacy in Iowa

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 18, 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.