Walmart Inc.
Organization Active NPI Community/Retail Pharmacy · Gunnison, CO
NPI 1902823263 · NPPES record last updated May 27, 2025
Key facts
- NPI
- 1902823263
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Community/Retail Pharmacy 3336C0003X
- License
- 570000003 (CO)
- Legal business name
- WALMART INC.
- Practice address
- 900 N Main St
Gunnison, CO 81230-2416 - Phone
- (970) 641-1145
- NPI assigned
- Jul 16, 2006
- Organization subpart
- No
Authorized official
- Name
- Kimberly Canonic
- Title
- Senior Director, Enrollment
- Phone
- (480) 277-6348
Corporate family (same tax ID) 24
Practitioners 2
-
Christina Joanne Damm, PHARMD
-
Mandy Hemmert, PHARMD
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 06D2157322 | Walmart Pharmacy #10-1550 | Certificate of waiver | Nov 4, 2026 |
Medicare medical equipment & supply locations
| Supplier | Supplies | Medicare assignment |
|---|---|---|
| Wal-Mart Pharmacy 1550 |
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 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in CO
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20100930003864 | CO | DME Supplier - Pharmacy | 4385556745 | Practice locations: Gunnison, CO |
| O20130803000036 | CO | Part B Supplier - Mass Immunization (Roster Biller Only) | 4385556745 | This NPI is an additional NPI on the enrollment |
National Provider Directory
- Tax ID family
- Ability Network
Locations
900 N Main St
Bldg A
Gunnison, CO 81230
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Durable Medical Equipment & Medical Supplies | 332B00000X | |||
| Pharmacy | 333600000X | |||
| Community/Retail Pharmacy | 3336C0003X | 570000003 | CO | Yes |
Addresses
Primary practice location
900 N Main St
Gunnison, CO 81230-2416
Mailing address
702 SW 8TH St
Bentonville, AR 72716-0445
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 03000668 | Medicaid | CO | |
| 3000668 | Medicaid | CO | |
| 2002005 | Other | PK |
Other names
- WALMART PHARMACY 10-1550
Electronic endpoints
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| CONNECT URL | https://esmd.abilitynetwork.com:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRRequest_Service | Other | Ability Network |
Other providers in Gunnison, CO
- Amy Elizabeth Vanderveer
- Kathleen Vandervoort-Chapel
- Laura A Villanueva
- Jessica Lauren Vogan
- Breanna C Vose
- Matthew G Wark
- Kelsey Weaver
- Wellness Elevated
- Western Colorado Hearing Clinic
- Western Slope Mental Health PLLC
All providers in Gunnison, CO · Community/Retail Pharmacy in Colorado
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 27, 2025. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.