Active NPI
Walmart Inc.
Doing business as Walmart Pharmacy 10-2188
- Community/Retail Pharmacy
- Eagle River, AK
National Provider Identifier
1972520286
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Community/Retail Pharmacy
- License
- PHAR353
- Legal business name
- WALMART INC.
- Doing business as
- Walmart Pharmacy 10-2188
- Practice address
- 18600 Eagle River Rd
Eagle River, AK 99577-8688 - Phone
- (907) 694-9786
- Fax
- (907) 694-9799
- NPI assigned
- Jul 16, 2006
- 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 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Durable Medical Equipment & Medical Supplies | 332B00000X | |||
| Pharmacy | 333600000X | |||
| Community/Retail Pharmacy | 3336C0003X | PHAR353 | AK | Primary |
Addresses
Primary practice location
18600 Eagle River Rd
Eagle River, AK 99577-8688
Mailing address
702 SW 8TH St
Bentonville, AR 72716-0445
Phone (479) 204-8550
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1996977 | Other | PK | |
| PH0255 | Medicaid | AK |
Other names 1
- WALMART PHARMACY 10-2188
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 AK
Enrollment records 3
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20100930042384 | AK | DME Supplier - Pharmacy | 4385556745 | Practice locations: Eagle River, AK |
| O20130808000548 | AK | Part B Supplier - Mass Immunization (Roster Biller Only) | 4385556745 |
9 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Kodiak, AK; Wasilla, AK; Ketchikan, AK; Kenai, AK; Fairbanks, AK; Eagle River, AK; Anchorage, AK |
| O20231212003400 | AK | Part B Supplier - Independent Clinical Laboratory | 4385556745 |
8 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Anchorage, AK; Eagle River, AK; Fairbanks, AK; Kenai, AK; Ketchikan, AK; Kodiak, AK; Wasilla, AK |
Other NPIs on the same Medicare enrollment 9
NPIs listed together on one Medicare enrollment, typically parts of the same organization.
-
dba Wal-Mart Pharmacy 10-3814
- Community/Retail Pharmacy
- Juneau, AK
- NPI 1629277108
O20130808000548
-
dba Walmart Pharmacy 10-2711
- Community/Retail Pharmacy
- Kodiak, AK
- NPI 1063439370
O20130808000548, O20231212003400
-
dba Walmart Pharmacy 10-2070
- Community/Retail Pharmacy
- Anchorage, AK
- NPI 1245257559
O20130808000548, O20231212003400
-
dba Walmart Pharmacy 10-4474
- Community/Retail Pharmacy
- Kenai, AK
- NPI 1285965772
O20130808000548, O20231212003400
-
dba Walmart Pharmacy 10-2074
- Community/Retail Pharmacy
- Wasilla, AK
- NPI 1336166644
O20130808000548, O20231212003400
-
dba Walmart Pharmacy 10-2071
- Community/Retail Pharmacy
- Anchorage, AK
- NPI 1427075738
O20130808000548, O20231212003400
-
- Community/Retail Pharmacy
- Anchorage, AK
- NPI 1427497767
O20130808000548, O20231212003400
-
dba Walmart Pharmacy 10-2722
- Community/Retail Pharmacy
- Fairbanks, AK
- NPI 1447277652
O20130808000548, O20231212003400
-
dba Walmart Pharmacy 10-2710
- Community/Retail Pharmacy
- Ketchikan, AK
- NPI 1710904925
O20130808000548, O20231212003400
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 |
|---|---|---|---|
| 02D2142155 | Walmart Inc 2188 | Certificate of waiver | Jan 3, 2028 |
Medicare medical equipment & supply locations
| Supplier | Supplies | Medicare assignment |
|---|---|---|
| Wal-Mart Pharmacy 10-2188 | 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 12
This tax ID family is large, so up to 24 of its organizations in the same state are linked here.
-
- Community/Retail Pharmacy
- Anchorage, AK
- NPI 1427497767
Locations
18600 Eagle River Rd
Eagle River, AK 99577
Phone (907) 694-9780
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1153008000000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1748822400000",
"number": "1972520286",
"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": "18600 EAGLE RIVER RD",
"city": "EAGLE RIVER",
"state": "AK",
"postal_code": "995778688",
"telephone_number": "907-694-9786",
"fax_number": "907-694-9799"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "WALMART INC.",
"organizational_subpart": "NO",
"enumeration_date": "2006-07-16",
"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": 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": "AK",
"license": "PHAR353",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PK",
"identifier": "1996977",
"state": null
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "PH0255",
"state": "AK"
}
],
"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 10-2188",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in Eagle River, AK
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.
- 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.