Active NPI
Walmart Inc.
Doing business as WalMart Pharmacy 10-2181
- Community/Retail Pharmacy
- Indio, CA
National Provider Identifier
1861892754
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Community/Retail Pharmacy
- License
- PHY52007
- Legal business name
- WALMART INC.
- Doing business as
- WalMart Pharmacy 10-2181
- Practice address
- 82491 Avenue 42
Indio, CA 92203-9307 - Phone
- (760) 262-5830
- Fax
- (760) 262-8517
- NPI assigned
- Aug 27, 2014
- Last updated
- Jun 2, 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Durable Medical Equipment & Medical Supplies | 332B00000X | NU | ||
| Community/Retail Pharmacy | 3336C0003X | PHY52007 | CA | Primary |
Addresses
Primary practice location
82491 Avenue 42
Indio, CA 92203-9307
Mailing address
702 SW 8TH St
Bentonville, AR 72716-0445
Phone (479) 258-2115
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 2147618 | Other | PK | |
| 1861892754 | Medicaid | CA |
Other names 1
- WalMart Pharmacy 10-2181
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 |
| O20150115001276 | CA | DME Supplier - Pharmacy | 4385556745 | Practice locations: Indio, CA |
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 Vision Center 30-2948
- Eyewear Supplier
- Santa Fe Springs, CA
- NPI 1851477053
-
dba Vision Center 30-3652
- Eyewear Supplier
- West Sacramento, CA
- NPI 1871717256
Locations
82491 Avenue 42
Indio, CA 92203
Phone (760) 262-5830
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1409097600000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1748822400000",
"number": "1861892754",
"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": "479-258-2115",
"fax_number": "479-277-4331"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "82491 AVENUE 42",
"city": "INDIO",
"state": "CA",
"postal_code": "922039307",
"telephone_number": "760-262-5830",
"fax_number": "760-262-8517"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "WALMART INC.",
"organizational_subpart": "NO",
"enumeration_date": "2014-08-27",
"last_updated": "2025-06-02",
"certification_date": "2025-06-02",
"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": "CA",
"license": "PHY52007",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PK",
"identifier": "2147618",
"state": null
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1861892754",
"state": "CA"
}
],
"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 10-2181",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in Indio, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 2, 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.