Walmart Inc.

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

2-09918 Issued in KS

Legal business name

WALMART INC.

Practice address

3503 10TH St
Great Bend, KS 67530-3538

Phone

(620) 792-5237

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) 277-6348

Specialties & licenses 3

Addresses

Other identifiers 3

Other names 1

• WALMART PHARMACY 10-0770 Doing business as

Medicare fee-for-service enrollment

Enrolled in KS2 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.

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
  • Topeka, KS
  • NPI 1669520383
  NPD tax ID
• Wal-Mart Stores Inc

  • Eyewear Supplier
  • Great Bend, KS
  • NPI 1649351610
  NPD tax ID
• Wal-Mart Stores Inc

  • Eyewear Supplier
  • Olathe, KS
  • NPI 1760657530
  NPD tax ID
• Wal-Mart Stores, Inc.

  • Optician
  • Leavenworth, KS
  • NPI 1669600490
  NPD tax ID
• Wal-Mart Stores, Inc.

  • Eyewear Supplier
  • Overland Park, KS
  • NPI 1689756371
  NPD tax ID
• Wal-Mart Stores, Inc.

  • Eyewear Supplier
  • Independence, KS
  • NPI 1710069778
  NPD tax ID
• Wal-Mart Stores, Inc.

  • Optician
  • Dodge City, KS
  • NPI 1760259600
  NPD tax ID
• Wal-Mart Stores, Inc.

  • Optician
  • Topeka, KS
  • NPI 1790566354
  NPD tax ID
• Wal-Mart Stores, Inc.

  • Eyewear Supplier
  • Shawnee, KS
  • NPI 1801986088
  NPD tax ID
• Walmart Inc.

  • Community/Retail Pharmacy
  • Chanute, KS
  • NPI 1649297045
  NPD tax ID
• Walmart Inc.

  • Community/Retail Pharmacy
  • Junction City, KS
  • NPI 1649297052
  NPD tax ID
• Walmart Inc.

  • Community/Retail Pharmacy
  • Overland Park, KS
  • NPI 1649297060
  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": "1748908800000",
    "number": "1720005127",
    "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": "3503 10TH ST",
            "city": "GREAT BEND",
            "state": "KS",
            "postal_code": "675303538",
            "telephone_number": "620-792-5237"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WALMART INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-16",
        "last_updated": "2025-06-03",
        "certification_date": "2025-06-03",
        "status": "A",
        "authorized_official_last_name": "CANONIC",
        "authorized_official_first_name": "KIMBERLY",
        "authorized_official_title_or_position": "SENIOR DIRECTOR, ENROLLMENT",
        "authorized_official_telephone_number": "480-277-6348"
    },
    "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": "KS",
            "license": "2-09918",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "6010831827",
            "state": "KS"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2032107",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100433240A",
            "state": "KS"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "WALMART PHARMACY 10-0770",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Tareia Vogelgesang, R.PH.
• Ashley Rae Vonada, PA-C
• Mary T Vuong, OTR
• Wal-Mart Stores Inc
• Walgreen Co
• Steven O. Walters, LCP
• Harly Watkins
• Krysten Watkins
• Karina Nicole Weigel, LPC
• Julie K West, PAC

• All providers in Great Bend, KS
• Community/Retail Pharmacy in Kansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 3, 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.