Walmart Inc.

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

054009638 Issued in IL

Legal business name

WALMART INC.

Practice address

18600 Shipman Rd
Carlinville, IL 62626-9223

Phone

(217) 854-2660

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 1

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in IL2 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
  • Paris, IL
  • NPI 1730262387
  NPD tax ID
• Wal-Mart Stores, Inc

  • Eyewear Supplier
  • Rockford, IL
  • NPI 1750463675
  NPD tax ID
• Wal-Mart Stores, Inc

  • Eyewear Supplier
  • Country Club Hills, IL
  • NPI 1750466066
  NPD tax ID
• Wal-Mart Stores, Inc

  • Eyewear Supplier
  • Kewanee, IL
  • NPI 1760563779
  NPD tax ID
• Wal-Mart Stores, Inc

  • Eyewear Supplier
  • Taylorville, IL
  • NPI 1790868917
  NPD tax ID
• Wal-Mart Stores, Inc.

  • Eyewear Supplier
  • Oswego, IL
  • NPI 1710183645
  NPD tax ID
• Wal-Mart Stores, Inc.

  • Eyewear Supplier
  • Silvis, IL
  • NPI 1710362918
  NPD tax ID
• Wal-Mart Stores, Inc.

  • Eyewear Supplier
  • Carpentersville, IL
  • NPI 1780039115
  NPD tax ID
• Wal-Mart Stores, Inc.

  • Eyewear Supplier
  • Chicago, IL
  • NPI 1780782276
  NPD tax ID
• Wal-Mart Stores, Inc.

  • Optician
  • Joliet, IL
  • NPI 1801070636
  NPD tax ID
• Wal-Mart Stores, Inc.

  • Eyewear Supplier
  • Zion, IL
  • NPI 1801271002
  NPD tax ID
• Wal-Mart Stores, Inc. Dba Wal-Mart

  • Eyewear Supplier
  • Waukegan, IL
  • NPI 1710015219
  NPD tax ID

Locations

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

{
    "created_epoch": "1153008000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1748563200000",
    "number": "1760409031",
    "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": "18600 SHIPMAN RD",
            "city": "CARLINVILLE",
            "state": "IL",
            "postal_code": "626269223",
            "telephone_number": "217-854-2660"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WALMART INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-16",
        "last_updated": "2025-05-30",
        "certification_date": "2025-05-30",
        "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": "IL",
            "license": "054009638",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2019810",
            "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": []
}

• Michelle Renee Tiburzi, D.C.
• Vna Homecare, Inc.
• Vna Homecare, Inc.
• Mark W. Wade, D.C.
• Deborah Faye Wallace, LCPC LICENSED CLINIC
• Amanda L Watermeier, PHARMD
• Courtney Lynn Waters
• Michael Robert Wattles, D.M.D.
• Ryan Watts, RN
• Jamie Yvonne Welty, DNP, FNP-BC

• Community/Retail Pharmacy in Carlinville, IL
• Providers in Carlinville, IL by specialty
• Community/Retail Pharmacy in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 30, 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.