NPIMap

Organization Active NPI

Walmart Inc.

Doing business as Walmart Pharmacy 10-3129

  • Community/Retail Pharmacy
  • Eastvale, CA
National Provider Identifier
1770458945
Registry record updated Oct 8, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
Legal business name
WALMART INC.
Doing business as
Walmart Pharmacy 10-3129
Practice address
14100 Limonite Ave
Eastvale, CA 92880-3855
Phone
(909) 563-2577
Fax
(909) 863-2578
NPI assigned
Oct 8, 2025
Last updated
Oct 8, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 8, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Kimberly Canonic
Title
Senior Director
Phone
(479) 371-1168

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Durable Medical Equipment & Medical Supplies 332B00000X NU
Community/Retail Pharmacy 3336C0003X NU Primary

Addresses

Primary practice location

14100 Limonite Ave
Eastvale, CA 92880-3855

Mailing address

1 Customer Dr
Bentonville, AR 72716-0445

Other names 1

  • Walmart Pharmacy 10-3129 Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20140203000875 CA Part B Supplier - Mass Immunization (Roster Biller Only) 4385556745 This NPI is an additional NPI on the enrollment
O20260226001343 CA DME Supplier - PharmacyDME Supplier - Optician 4385556745 Practice locations: Eastvale, CA

National Provider Directory

National Provider Directory
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.

View all 24

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

  • Walmart Inc.

    dba Walmart Pharmacy 10-1588

    • Community/Retail Pharmacy
    • Victorville, CA
    • NPI 1043237456

    Member Of

    NPD member

Locations (25 of 1,271)

3101 A St
Anchorage, AK 99503
Phone (907) 563-6600

7405 Debarr Rd
Anchorage, AK 99504
Phone (907) 339-9037

8900 Old Seward Hwy
Anchorage, AK 99515
Phone (907) 344-7300

6525 Glacier Hwy
Juneau, AK 99801
Phone (907) 789-2440

367 W Cherry St
#100358
Alma, AR 72921
Phone (479) 632-4330

109 Malone Dr
#100318
Arkadelphia, AR 71923
Phone (870) 246-5410

219 Highway 62 412
#100160
Ash Flat, AR 72513
Phone (870) 994-2152

297 Highway 32 Byp
Ashdown, AR 71822
Phone (870) 898-2142

297 Highway 32 Byp
#100133
Ashdown, AR 71822
Phone (870) 898-2142

3150 Harrison St
#100119
Batesville, AR 72501
Phone (870) 793-4464

2003 W Center St
Beebe, AR 72012
Phone (501) 882-1516

17309 Interstate 30 S
#100085
Benton, AR 72015
Phone (501) 778-5041

1 Customer Dr
#102203
Bentonville, AR 72716
Phone (479) 552-0297

1400 N Walton Blvd
Bentonville, AR 72712
Phone (479) 268-9800

1703 E Central Ave
Bentonville, AR 72712
Phone (479) 418-0229

205 N Main St
#103164
Bentonville, AR 72712
Phone (479) 268-9243

3510 SE 14th St
Bentonville, AR 72712
Phone (479) 621-6470

3510 SE 14th St
#102741
Bentonville, AR 72712
Phone (479) 621-6470

406 S Walton Blvd
Bentonville, AR 72712
Phone (479) 271-0301

406 S Walton Blvd
#100100
Bentonville, AR 72712
Phone (479) 273-5080

906 SW Regional Airport Blvd
Bentonville, AR 72713
Phone (479) 268-7015

1000 W Trimble Ave
#100076
Berryville, AR 72616
Phone (870) 423-6611

3700 E Highway 18
#100062
Blytheville, AR 72315
Phone (870) 763-1013

1400 E Main St
Booneville, AR 72927
Phone (479) 675-5341

1400 E Main St
#100055
Booneville, AR 72927
Phone (479) 675-5341

Practitioners & affiliated clinicians

Practitioners 1,118

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.

View all 1,118

NPI Registry JSON

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

{
    "created_epoch": "1759881600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1759881600000",
    "number": "1770458945",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1 CUSTOMER DR",
            "city": "BENTONVILLE",
            "state": "AR",
            "postal_code": "727160445"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14100 LIMONITE AVE",
            "city": "EASTVALE",
            "state": "CA",
            "postal_code": "928803855",
            "telephone_number": "909-563-2577",
            "fax_number": "909-863-2578"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WALMART INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2025-10-08",
        "last_updated": "2025-10-08",
        "certification_date": "2025-10-08",
        "status": "A",
        "authorized_official_last_name": "CANONIC",
        "authorized_official_first_name": "KIMBERLY",
        "authorized_official_title_or_position": "SENIOR DIRECTOR",
        "authorized_official_telephone_number": "479-371-1168"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Walmart Pharmacy 10-3129",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Eastvale, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 8, 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.

Verify at the official NPI Registry.