NPIMap

Walmart Inc.

Organization Active NPI Community/Retail Pharmacy · Pittsfield, IL

NPI 1912925439 · NPPES record last updated May 30, 2025

Key facts

NPI
1912925439
Entity type
Organization (NPI type 2)
Primary specialty
Community/Retail Pharmacy 3336C0003X
License
054012032 (IL)
Legal business name
WALMART INC.
Practice address
151 Shetland Dr
Pittsfield, IL 62363-1643
Phone
(217) 285-9709
NPI assigned
Jul 17, 2006
Organization subpart
No

Authorized official

Name
Kimberly Canonic
Title
Senior Director, Enrollment
Phone
(480) 277-6348

Corporate family (same tax ID) 24

Organizations that report the same tax identification number in the National Provider Directory.

Laboratory certificates & supplier records

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

Medicare medical equipment & supply locations

SupplierSuppliesMedicare assignment
Wal-Mart Pharmacy 10-0480
151 Shetland Drive, Pittsfield, IL 62363-1643 · (217) 285-9709		 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)|Canes and/or Crutches|Walkers|Ostomy Supplies|Prosthetic Lenses: Conventional Eyeglasses|Enteral N… Does not accept assignment
Participating since Jan 1, 2019

Medicare participation

Medicare fee-for-service enrollment
Enrolled (2 enrollments) in IL

Medicare enrollment records

Enrollment IDStateProvider typePAC IDDetails
O20100930088424 IL DME Supplier - Pharmacy
DME Supplier - Optician		 4385556745 Practice locations: Pittsfield, IL
O20130814000649 IL 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 (2,173 organizations share this tax ID)

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Durable Medical Equipment & Medical Supplies 332B00000X
Pharmacy 333600000X
Community/Retail Pharmacy 3336C0003X 054012032 IL Yes

Addresses

Primary practice location

151 Shetland Dr
Pittsfield, IL 62363-1643

Mailing address

702 SW 8TH St
Bentonville, AR 72716-0445
Phone (479) 277-1242

Other identifiers

IdentifierTypeStateIssuer
2023448OtherPK

Electronic endpoints

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

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on May 30, 2025.

{
    "created_epoch": "1153094400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1748563200000",
    "number": "1912925439",
    "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": "479-277-1242"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "151 SHETLAND DR",
            "city": "PITTSFIELD",
            "state": "IL",
            "postal_code": "623631643",
            "telephone_number": "217-285-9709"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WALMART INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-17",
        "last_updated": "2025-05-30",
        "certification_date": "2025-05-30",
        "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": null,
            "license": null,
            "primary": false
        },
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "IL",
            "license": "054012032",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2023448",
            "state": null
        }
    ],
    "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": []
}

Other providers in Pittsfield, IL

All providers in Pittsfield, IL · Community/Retail Pharmacy in Illinois

Sources for this page

Verify at the official NPI Registry.