Walmart Inc.
Walmart Inc. is a healthcare organization registered as Community/Retail Pharmacy in Pueblo, CO, holding Type 2 (organization) NPI 1568489821 since 2006. The authorized official on file is Kimberly Canonic, Senior Director, Enrollment.
✓ Active NPI ✓ Valid NPI checksum
| NPI | 1568489821 |
|---|---|
| Entity type | Organization (Type 2) |
| Legal business name | Walmart Inc. |
| Other name | <Unavail> |
| Practice address | 4080 W NORTHERN AVE, Pueblo, CO, 81005 |
| Phone | 7195610951 |
| Enumeration date | 2006-07-16 |
| Last updated in NPPES | 2025-06-05 |
Authorized official
| Name | Kimberly Canonic |
|---|---|
| Title | Senior Director, Enrollment |
| Phone | 4802776348 |
Taxonomy & classification
| Taxonomy code | Specialty | Primary | License | State |
|---|---|---|---|---|
| 332B00000X | Durable Medical Equipment & Medical Supplies | Secondary | — | — |
| 333600000X | Pharmacy | Secondary | — | — |
| 3336C0003X | Community/Retail Pharmacy | Primary | 1040000048 | CO |
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 03015450 | Medicaid | CO | — |
| 315450 | Medicaid | CO | — |
| 2001797 | Other | — | PK |
Copy-ready billing details
Provider: Walmart Inc. NPI: 1568489821 Taxonomy: 3336C0003X (Community/Retail Pharmacy) Address: 4080 W NORTHERN AVE, Pueblo, CO, 81005
Providers at this address
| NPI | Name | Type | Specialty | Location |
|---|---|---|---|---|
| 1508948241 | Wal-Mart Stores, Inc. | Organization | Eyewear Supplier | Pueblo, CO |
| 1023218435 | Cameran Drake | Individual | Optometrist | Pueblo, CO |
| 1629278049 | Jenni Drake | Individual | Optometrist | Pueblo, CO |
| 1881063303 | 3d Vision, Inc | Organization | Optometrist | Pueblo, CO |
| 1982121836 | Jefferey Chheuy | Individual | Pharmacist | Pueblo, CO |
| 1639654296 | Nancy Roth | Individual | Pharmacist | Pueblo, CO |
| 1386201788 | Rieko Mukai | Individual | Pharmacist | Pueblo, CO |
| 1528627742 | Clay Creppel | Individual | Pharmacist | Pueblo, CO |
Verify this record
Cross-check NPI 1568489821 against the authoritative CMS record: view Walmart Inc. on the official NPPES registry .
What is an NPI number?
A National Provider Identifier (NPI) is a unique 10-digit number that CMS assigns to every U.S. healthcare provider and organization under HIPAA. Type 1 NPIs identify individual providers; Type 2 NPIs identify organizations. The NPI appears on insurance claims, prescriptions, and credentialing paperwork, and never changes — even if the provider moves or changes specialty. Read the full guide or validate an NPI number.
Frequently asked questions
How current is this record?
Where is Walmart Inc. located?
Source: CMS NPPES (public data). Snapshot 2026-07-10. Provider record last updated 2025-06-05.