MEDICARE: WALMART INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332B00000X	Durable Medical Equipment & Medical Supplies
2	333600000X	Pharmacy
3	3336C0003X	Community/Retail Pharmacy	PHY38993	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
1	2043384	OTHER	PK
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1215954631
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WALMART INC.

Provider Business Mailing Address
First Line	:	1 CUSTOMER DR
Second Line	:	MS 0445
City	:	BENTONVILLE
State	:	AR
Zip	:	72716-0445
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	7901 WATT AVE
Second Line	:
City	:	ANTELOPE
State	:	CA
Zip	:	95843-2000
Country	:	US
Telephone Number	:	916-332-4427
Fax Number	:	916-332-4130

Authorized Official
Title or Position	:	SENIOR DIRECTOR, ENROLLMENT
Name	:	KIMBERLY CANONIC
Credential	:
Telephone Number	:	480-853-0515

Provider Enumeration Date	:	07/16/2006
Last Update Date	:	09/29/2025

Similar Medicare Providers

1629166962 — WALMART STORES, INC.
Practice Location Address:

7901 WATT AVE
ANTELOPE, CA
95843-2000

Practice Phone: 916-332-3173
Practice Fax:

1447389796 — STACY ALLISON BRAGG O.D.
Practice Location Address:

7901 WATT AVE
ANTELOPE, CA
95843-2000

Practice Phone: 916-332-4904
Practice Fax:

1861672057 — FIRSTSIGHT VISION SERVICES, INC.
Practice Location Address:

7901 WATT AVE
ANTELOPE, CA
95843-2000

Practice Phone: 916-332-4904
Practice Fax: 916-332-6541

1043251176 — MR. WILLIAM JOHN BLACK D.D.S.
Practice Location Address:

2925 ELVERTA RD
ANTELOPE, CA
95843-9106

Practice Phone: 916-331-6288
Practice Fax: 916-331-0760

1104831486 — WALGREEN CO
Practice Location Address:

4331 ANTELOPE RD
SACRAMENTO, CA
95843-6022

Practice Phone: 916-722-3304
Practice Fax: 916-722-1845

1235245168 — MR. VIMAL AMRAL DULABH DDS
Practice Location Address:

3535 ELVERTA RD , SUITE E
ANTELOPE, CA
95843

Practice Phone: 916-349-9990
Practice Fax: 916-349-9991

Directions to “WALMART INC. ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.