Active NPI
Walmart Inc.
Doing business as Walmart Pharmacy 10-5663
- Community/Retail Pharmacy
- Riverside, CA
National Provider Identifier
1851716138
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Community/Retail Pharmacy
- License
- 51826
- Legal business name
- WALMART INC.
- Doing business as
- Walmart Pharmacy 10-5663
- Practice address
- 8844 Limonite Ave
Riverside, CA 92509-5021 - Phone
- (951) 968-7222
- Fax
- (951) 968-7223
- NPI assigned
- Feb 24, 2014
- Last updated
- Jun 5, 2025
- Organization subpart
- No
NPPES NPI Registry
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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Community/Retail Pharmacy | 3336C0003X | 51826 | CA | Primary |
Addresses
Primary practice location
8844 Limonite Ave
Riverside, CA 92509-5021
Mailing address
702 SW 8TH St
Bentonville, AR 72716-0445
Phone (479) 204-8550
Other names 1
- Walmart Pharmacy 10-5663
Electronic endpoints 1
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| 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 CA
Enrollment records 2
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20140203000875 | CA | Part B Supplier - Mass Immunization (Roster Biller Only) | 4385556745 | This NPI is an additional NPI on the enrollment |
| O20141121002060 | CA | DME Supplier - Pharmacy | 4385556745 | Practice locations: Jurupa Valley, CA |
Laboratory certificates & supplier records
Derived by NPIMapThese CMS records do not include an NPI. They are shown because their name and street address match this provider’s.
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 05D2338985 | Walmart Pharmacy #10-5663 | Certificate of waiver | Feb 19, 2028 |
Medicare medical equipment & supply locations
| Supplier | Supplies | Medicare assignment |
|---|---|---|
| Wal-Mart Pharmacy 10-5663 | 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|Enteral Nutrients|Surgical Dressings | Does not accept assignment |
National Provider Directory
National Provider Directory- Tax ID family
- Ability Network
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.
-
dba Wal-Mart Vision Center 30-1915
- Eyewear Supplier
- Yucca Valley, CA
- NPI 1841631090
-
dba Vision Center 30-2948
- Eyewear Supplier
- Santa Fe Springs, CA
- NPI 1851477053
-
dba Vision Center 30-3652
- Eyewear Supplier
- West Sacramento, CA
- NPI 1871717256
-
dba Walmart Pharmacy 10-2636
- Community/Retail Pharmacy
- Huntington Beach, CA
- NPI 1851318109
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1393200000000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1749081600000",
"number": "1851716138",
"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",
"telephone_number": "479-204-8550",
"fax_number": "479-277-4331"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "8844 LIMONITE AVE",
"city": "RIVERSIDE",
"state": "CA",
"postal_code": "925095021",
"telephone_number": "951-968-7222",
"fax_number": "951-968-7223"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "WALMART INC.",
"organizational_subpart": "NO",
"enumeration_date": "2014-02-24",
"last_updated": "2025-06-05",
"certification_date": "2025-06-05",
"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": "3336C0003X",
"taxonomy_group": "",
"desc": "Pharmacy, Community/Retail Pharmacy",
"state": "CA",
"license": "51826",
"primary": true
}
],
"identifiers": [],
"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 10-5663",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in Riverside, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 5, 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.