NPIMap

Organization Active NPI

Walmart Inc.

Doing business as Walmart Pharmacy 10-3754

  • Community/Retail Pharmacy
  • Chelan, WA
National Provider Identifier
1841355815
Registry record updated Jul 7, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
License
CF00058936 Issued in WA
Legal business name
WALMART INC.
Doing business as
Walmart Pharmacy 10-3754
Practice address
108 N Apple Blossom Dr
Chelan, WA 98816-8679
Phone
(509) 682-4634
NPI assigned
Dec 27, 2006
Last updated
Jul 7, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 7, 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, Enrollment
Phone
(480) 277-6348

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Durable Medical Equipment & Medical Supplies 332B00000X NU
Community/Retail Pharmacy 3336C0003X CF00058936 WA Primary

Addresses

Primary practice location

108 N Apple Blossom Dr
Chelan, WA 98816-8679

Mailing address

100 N 6TH St
#900A
Minneapolis, MN 55403-1505
Phone (479) 277-1242

Other identifiers 4

IdentifierTypeStateIssuer
2109030OtherPK
6031041DMEMedicaidWA
6031041MedicaidWA
60310401MedicaidWA

Other names 1

  • WALMART PHARMACY 10-3754 Doing business as

Electronic endpoints 1

TypeEndpointUseAffiliation
CONNECT URL https://esmd.abilitynetwork.com:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRRequest_Service Other Ability Network

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WA2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20100930042896 WA DME Supplier - PharmacyDME Supplier - Optician 4385556745 Practice locations: Chelan, WA
O20131010000609 WA Part B Supplier - Mass Immunization (Roster Biller Only) 4385556745 This NPI is an additional NPI on the enrollment

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
50D2177765Walmart Pharmacy #10-3754108 Apple Blossom Dr, Chelan, WA 98816Certificate of waiverApr 4, 2028

Medicare medical equipment & supply locations

SupplierSuppliesMedicare assignment
Walmart Pharmacy 10-3754108 Apple Blossom Dr, Chelan, WA 98816-8679(509) 682-4634 Epoetin|Immunosuppressive Drugs|Infusion Drugs|Nebulizer Drugs|Oral Anticancer Drugs|Oral Antiemetic Drugs|Blood Glucose Monitors/Supplies (Non-Mail Order)|Blood Glucose Monitors/Supplies (Mail Order)|Ostomy Supplies|Prosthetic Lenses: Conventional Eyeglasses|Enteral Nutrients|Surgical Dressings Does not accept assignmentParticipating since Jan 1, 2019

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 23

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

View all 23

Locations

108 N Apple Blossom Dr
Chelan, WA 98816
Phone (509) 682-2195

NPI Registry JSON

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

{
    "created_epoch": "1167177600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1751846400000",
    "number": "1841355815",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 N 6TH ST",
            "address_2": "#900A",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554031505",
            "telephone_number": "479-277-1242"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "108 N APPLE BLOSSOM DR",
            "city": "CHELAN",
            "state": "WA",
            "postal_code": "988168679",
            "telephone_number": "509-682-4634"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WALMART INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-27",
        "last_updated": "2025-07-07",
        "certification_date": "2025-07-07",
        "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": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "WA",
            "license": "CF00058936",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2109030",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "6031041DME",
            "state": "WA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "6031041",
            "state": "WA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "60310401",
            "state": "WA"
        }
    ],
    "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 10-3754",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Chelan, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 7, 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.